title: Perioperative synbiotic therapy in elderly patients undergoing gastroenterological surgery: a prospective, randomized control trial.
abstract: OBJECTIVE
  Enteral administration of synbiotics has been reported to be beneficial during various types of surgery, but its clinical value in elderly surgical patients remains unclear. The aim of this study was to quantitatively evaluate the changes in gut microbiota and environment induced by perioperative synbiotic therapy, and to investigate whether it is possible to reduce infectious complications in elderly patients undergoing gastroenterological surgery.
  
  
  METHODS
  Forty-eight patients over the age of 70 y were randomized into a group receiving 7 d of preoperative and 10 d of postoperative synbiotic therapy (S group) and a control group without synbiotic therapy (C group). A fecal sample collected before and after surgery in each group was used for a quantitative evaluation of the microbiota.
  
  
  RESULTS
  Forty-eight patients completed the trial (25 in the S group and 23 in the C group). Synbiotic therapy significantly maintained the status of Bifidobacterium and Lactobacillus, whereas the number of Enterobacteriaceae, Staphylococcus, and Pseudomonas was significantly decreased. The total organic acid and short-chain fatty acid concentrations were increased, and the pH was markedly decreased, in the S group compared with the C group. The incidence of postoperative infectious complications was 12% in the S group and 36% in the C group, however, the difference did not reach statistical significance (P = 0.06). A multivariate analysis revealed that only the use of perioperative blood transfusion was an independent risk factor for infectious complications.
  
  
  CONCLUSIONS
  Synbiotic therapy improved the intestinal microbial environment, and might decrease the incidence of infectious complications in elderly surgical patients.
authors.affiliation: Department of Surgery, Yamaguchi Grand Medical Center, Yamaguchi, Japan. mitsuyoshi0610@yahoo.co.jp
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Okazaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsukuma
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Suto
authors.forename: Kensuke
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Matsuo
authors.forename: Shinji
authors.initials: S
authors.lastname: Noshima
authors.forename: Nobuya
authors.initials: N
authors.lastname: Zempo
authors.forename: Takashi
authors.initials: T
authors.lastname: Asahara
authors.forename: Koji
authors.initials: K
authors.lastname: Nomoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001644:Bifidobacterium; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004755:Enterobacteriaceae; D005243:Feces / Q000382:microbiology; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015994:Incidence; D007778:Lactobacillus; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D011549:Pseudomonas; D013210:Staphylococcus; D058616:Synbiotics; D016896:Treatment Outcome
keywords: Complication; Elderly patient; Enteral nutrition; Infection; Synbiotic therapy