Randomised clinical trial of synbiotic therapy in elective surgical patients.
BACKGROUND
It is possible to manipulate the composition of the gastrointestinal microflora by administration of pre- and probiotics. This may help to preserve gut barrier function and reduce the incidence of septic morbidity.


OBJECTIVE
To assess the effects of a combination of pre- and probiotics (synbiotic) on bacterial translocation, gastric colonisation, systemic inflammation, and septic morbidity in elective surgical patients.


METHODS
Patients were enrolled two weeks prior to elective abdominal surgery. Seventy two patients were randomised to the synbiotic group and 65 to the placebo group. Patients were well matched regarding age and sex distribution, diagnoses, and POSSUM scores.


METHODS
Patients in the synbiotic group received a two week preoperative course of Lactobacillus acidophilus La5, Bifidobacterium lactis Bb-12, Streptococcus thermophilus, and Lactobacillus bulgaricus, together with the prebiotic oligofructose. Patients in the placebo group received placebo capsules and sucrose powder. At surgery, a nasogastric aspirate, mesenteric lymph node, and scrapings of the terminal ileum were harvested for microbiological analysis. Serum was collected preoperatively and on postoperative days 1 and 7 for measurement of C reactive protein, interleukin 6, and antiendotoxin antibodies. Septic morbidity and mortality were recorded.


RESULTS
There were no significant differences between the synbiotic and control groups in bacterial translocation (12.1% v 10.7%; p = 0.808, chi(2)), gastric colonisation (41% v 44%; p = 0.719), systemic inflammation, or septic complications (32% v 31%; p = 0.882).


CONCLUSIONS
In this study, synbiotics had no measurable effect on gut barrier function in elective surgical patients. Further studies investigating the place of pre- and probiotics in clinical practice are required.
Anderson
A D G
AD
Combined Gastroenterology Research Group, Scarborough Hospital, Woodlands Drive, Scarborough YO12 6QL, UK.
McNaught
C E
CE
Jain
P K
PK
MacFie
J
J
D000368:Aged; D000369:Aged, 80 and over; D018988:Bacterial Translocation; D016009:Chi-Square Distribution; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011300:Preoperative Care / Q000379:methods*; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D018805:Sepsis / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000517:prevention & control*; D017211:Treatment Failure