Probiotics May Be Harmful For Patients With Acute Pancreatitis

In
patients with advanced acute pancreatitis, probiotics are associated
with increased mortality and do not actually reduce the risk of
additional infection, according to an article published on February 14,
2008 in The Lancet.

Infectious complications and the
associated increased risk of mortality are prime concerns when caring
for patients with acute pancreatitis, a rapid inflammation of the
pancreas. Approximately one fifth of all patients with this disease
have necrotising pancreatitis, which has a 10-30 percent mortality
rate, usually attributed to these infectious complications. These
complications are postulated to be triggered by the overgrowth of
small-bowel bacteria. Previously, it has been suggested that the
prophylactic use of probiotics, sometimes called “good” bacteria, might
minimize infectious complications by keeping the growth of small-bowel
bacteria in check. Theoretically, this would help restore
gastrointestinal barrier function and adjust the immune response.

To
test this theory, Professor Hein Gooszen, University Medical Center
Utrecht, Netherlands, and colleagues performed a randomised,
double-blind, placebo controlled trial. 296 patients with predicted
severe acute pancreatitis were tested: 152 with probiotics, and 144
with a placebo. In each group, patients showed similar clinical
characteristics and severity of the disease. A random assignment was
made within 72 hours of symptom onset to receive a probiotic
preparation or a placebo, each administered enterally, via the
digestive tract, twice a day for 28 days. For the duration of their
admission and for a 90 day follow up, the patients were all monitored
for any infectious complications, for example: infected pancreatic
necrosis;聽bacteraemia, the presence of bacteria in the blood;
pneumonia; urosepsis, a serious type of urinary tract infection; or
infected ascites, fluid in the peritoneal cavity of the abdomen.

Patients
with infectious complications was similar in both groups. 46 patients
(30 percent) in the group administered probiotics and 41 (28 percent)
in the placebo group. However, many more patients died in the
probiotics group, 24 (16 percent) versus nine (six percent)
respectively. In the probiotics group, nine patients developed
bowel聽ischaemia, in which inflammation occurs due to an
inadequate
blood supply, and eight of these suffered a fatal outcome. In
comparison, no patients in the placebo group experienced this
complication.

In conclusion, the authors advise against the
administration of probiotics in patients at risk of severe acute
pancreatitis: “Our findings show that probiotics should not be
administered routinely in patients with predicted severe acute
pancreatitis, and that the
particular composition used here should be banned for the present
indication. Whether other
combinations of strains might have resulted in different results is
debatable, but, until the
underlying mechanism is actually revealed, administration of probiotics
in patients with
predicted severe acute pancreatitis must be regarded as unsafe. ”

They
emphasize that this is not safe treatment method. “Most importantly,
probiotics can no longer be considered to be harmless adjuncts to
enteral nutrition, especially in critically ill patients or patients at
risk for non-occlusive mesenteric ischaemia.”

Probiotic prophylaxis in predicted severe acute pancreatitis:
a randomised, double-blind, placebo-controlled trial

Marc
G H Besselink, Hjalmar C van Santvoort, Erik Buskens, Marja A
Boermeester, Harry van Goor, Harro M Timmerman, Vincent B Nieuwenhuijs,
Thomas L Bollen, Bert van Ramshorst, Ben J M Witteman, Camiel Rosman,
Rutger J Ploeg, Menno A Brink, Alexander F M Schaapherder, Cornelis H C
Dejong, Peter J Wahab, Cees J H M van Laarhoven, Erwin van der Harst,
Casper H J van Eijck, Miguel A Cuesta, Louis M A Akkermans, Hein G
Gooszen, for the Dutch Acute Pancreatitis Study Group
The Lancet,聽 February 14,
2008聽聽
DOI:10.1016/S0140-6736(08)60207-X
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Here For Abstract

Written by Anna Sophia McKenney

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