Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut in patients with sap: Randomized double blind prospective study

Abstract

Background: Experience with administration of Prebiotics/ Probiotics (Synbiotics) in patients with severe acute pancreatitis (SAP) has demonstrated immunomodulatory capacity of this treatment modality. Aim: Evaluation of the feasibility, effectiveness and perspective of the clinical application of early low volume oral Synbiotic/Prebiotic supplemented enteral stimulation of the gut in patients with SAP. Methods: During the period from 2005 to 2008 totally 90 SAP patients with signs of SIRS and/or MODS were prospectively enrolled in to the double-blind clinical trial. Patients were randomised according the feeding mode. Group I (n = 32) have received standard whole protein feeding formula. Group II (n = 30) and Group III (n = 28) have received early Synbiotic or Prebiotic supplements. Synbiotic consisted of four bioactive lactic acid bacteria and four bioactive plant fibres. Prebiotic consisted of fibres only. Oral administration of Synbiotics or Prebiotics mixed with standard enteral nutrition formula was commenced when patients were able to sip water. Results: Statistically significantly differed average volumes of orally administered blends as well as number of calories between Groups I/II and I/III,P = 0.001. Early oral administration of Synbiotic/Prebiotic supplements was associated with lower infection rate comparing to the Group I, (P = 0.03, P = 0.001), lower rate of surgical interventions, P = 0.005, as well as shorter ICU (P = 0.05) and Hospital stay (P = 0.03). Finally Synbiotic supplemented enteral stimulation of the gut resulted in reduced mortality rate comparing to the Group I, P = 0.02. Conclusion: Early low volume oral Synbiotic/Prebiotic supplemented enteral stimulation of the gut seems to be perspective complement to the routine treatment protocol of SAP. Positive therapeutic effect can be partially explained by the possible improvement of the gut barrier function.