[Combination of early nasojejunal feeding with modern synbiotic therapy in the treatment of severe acute pancreatitis (prospective, randomized, double-blind study)].
BACKGROUND
We showed previously that probiotics containing lactobacilli significantly improve the outcome of acute pancreatitis. "Synbiotic 2000", a new synbiotic composition with high colony forming unit (CFU) comprises four different types of pre- and probiotics. In this prospective, randomized, double-blind study we evaluated the role of "Synbiotic 2000" in the treatment of severe acute pancreatitis.


METHODS
Patients with severe acute pancreatitis were randomized into two groups. Nasojejunal feeding was commenced within 24 hours after admission in both groups and continued for at least seven days. The first group of patients received four different lactobacilli preparations with 10(10) CFU, respectively, and prebiotics containing four bioactive fibres (inulin, beta-glucan, resistant starch and pectin) in addition. Patients in the second (control) group received only prebiotics.


RESULTS
62 patients with severe acute pancreatitis completed the study. Altogether 8 patients died. We detected lower incidence of multiorgan failure (MOF), septic complications and mortality in the first group compared to the control, but the differences were statistically not significant. The total incidence of systemic inflammatory response syndrome (SIRS) and MOF were significantly different between the two groups (8 vs. 14; p < 0.05). Furthermore, the number patients recovering with complications were significantly less in the first group receiving modern synbiotic therapy compared to the control (p < 0.05). Finally, we found lower rate of late (over 48 hours) organ failure in the first versus the control group (3.0% vs. 17.2%).


CONCLUSIONS
Our results suggest that early nasojejunal feeding with synbiotic may prevent organ dysfunctions in the late phase of severe acute pancreatitis. In addition, our data also indicate that the infection of pancreatic necrosis may be associated with early phase organ failure.
Oláh
Attila
A
Petz Aladár Megyei Oktató Kórház, Gyor, Sebészeti Osztály. olah.seb@arrabonet.hu
Belágyi
Tibor
T
Issekutz
Akos
A
Olgyai
Gábor
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007444:Inulin / Q000627:therapeutic use; D007583:Jejunum; D007778:Lactobacillus; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D009666:Nose; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D010368:Pectins / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013213:Starch / Q000627:therapeutic use; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D047071:beta-Glucans / Q000627:therapeutic use
D047071:beta-Glucans; D010368:Pectins; D013213:Starch; D007444:Inulin