Role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis: a double-blind randomized controlled trial.
OBJECTIVE
To study the role of probiotics on gut permeability and endotoxemia in patients with acute pancreatitis (AP).


BACKGROUND
Bacterial translocation has been implicated in infective complications in AP, which has been shown to be prevented by probiotics.


METHODS
A double-blind, randomized placebo-controlled trial was conducted. Consecutive patients with AP presenting within 72 hours after the onset of abdominal pain or who had been nil orally at the time of presentation for up to 5 days were included in the study. The probiotic group received 4 sachets of Probiotics (2.5 billion bacteria per sachet) whereas the placebo group received 4 sachets of placebo for 7 days. Primary outcome measures were effect on gut permeability [assessed by lactulose/mannitol (L/M) excretion in urine] and endotoxemia assessed by endotoxin-core antibody types IgG and IgM (EndoCab IgG and IgM). Secondary outcome measures were mortality, total hospital/intensive care unit stay, abdominal discomfort, organ failure, C-reactive protein, and prealbumin levels. The study was prematurely stopped after the publication of probiotic prophylaxis in patients with predicted severe acute pancreatitis trial.


RESULTS
From March 2007 to May 2008, 50 patients with AP were included in the study (26 in placebo group and 24 in probiotic group). There was no difference after intervention in gut permeability, whereas values of C-reactive protein and immunoglobulins decreased significantly [IgG: 140 (20-920) to 90 (20-600) GGU/mL and IgM: 65 (13-230) to 51 (9-240) GMU/mL] in the probiotic group. No difference was observed in prealbumin values, duration of hospital/intensive care unit stay, and mortality in both the groups.


CONCLUSIONS
No significant trend was identified for an effect of probiotics on gut permeability or endotoxemia in AP. However, the study was underpowered owing to premature study termination.
Department of Gastroenterology and Human nutrition unit, All India Institute of Medical Sciences, New Delhi, India.
Brij
B
Sharma
Siddharth
S
Srivastava
Namrata
N
Singh
Vikas
V
Sachdev
Suman
S
Kapur
Anoop
A
Saraya
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018988:Bacterial Translocation / Q000502:physiology; D001644:Bifidobacterium / Q000145:classification / Q000502:physiology; D004311:Double-Blind Method; D019446:Endotoxemia / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007422:Intestines / Q000382:microbiology* / Q000503:physiopathology; D007778:Lactobacillus / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000628:therapy*; D010539:Permeability; D019936:Probiotics / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult