Effects of probiotics on bowel function restoration following ileostomy closure in rectal cancer patients: a randomized controlled trial

Abstract

Aim:The aim was to determine the efficacy of probiotics in restoring bowel function following ileostomy reversal in patients with rectal cancer.Method: This was a pilot, randomized, double-blind, placebo-controlled trial. The probiotic used in this study, Lactobacillus plantarum CJLP243, was derived from kimchi.Patients were randomly allocated to a probiotic or placebo group and medication was taken once daily from preoperative day 1 to day 21. Primary outcomes were the Memorial Sloan Kettering Cancer Centre Bowel Function Index (MSKCC BFI) instrument and the low anterior resection syndrome score. The secondary outcomes were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and CR29 questionnaire responses.Results: Forty patients were enrolled, and 36 patients (probiotics, n = 17; placebo, n = 19) completed the primary outcomes. Total scores for the MSKCC questionnaire (56.2 ± 12.0 vs. 55.0 ± 10.7, P = 0.356) and low anterior resection syndrome scores (33.3 ± 7.6 vs. 36.0 ± 5.3, P = 0.257) were not significantly different between the probiotic and placebo groups, respectively. In the MSKCC BFI, the postoperative dietary scale score at week 1 was significantly higher in the probiotic group (13.1 ± 3.8 vs. 9.0 ± 3.0, P < 0.001). There were no other significant differences between the two groups for any other questionnaire scores. Conclusion:There were no significant effects supporting the use of a probiotic for improved bowel function in patients following ileostomy reversal. Nevertheless, the administration of probiotics showed trends toward improvements in some subscale bowel function measures, suggesting further studies may be warranted.

Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

“…This correlation disappears between the third and sixth month, when diversion colitis becomes non-existent both endoscopically and microscopically. This fact coincides with the transitory and limited modulatory effect that probiotics produces on the intestinal mucosa (43)(44)(45)(46)(47) and with the recovery curve of intestinal function published in other studies (7,9). However, as the main limitation of our study has been the sample size we cannot make definitive statements about the effectiveness of this technique.…”

Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

“…We decided to carry out our study to compare results after stimulation of the efferent loop with probiotics in patients previously operated on for colorectal carcinoma. Based on systematic reviews about the use of probiotics as treatment of other gastrointestinal pathologies [ 18 , 19 , 20 ], we considered that this stimulation would achieve the repopulation of the excluded colon, activating the cellular absorption mechanisms, increasing motility, and decreasing efferent loop atrophy, so that after closure ileostomy, the return to normality would be faster, with a shorter time required to re-establish oral transit and tolerance, reducing the onset of postoperative ileus and the duration of hospital stay. We chose the formulation of probiotics with the highest number of strains, which had an adequate synergistic and complementary effect between them, and the highest concentration.…”

The Use of Prebiotic and Probiotic Interventions for Treating Gastrointestinal and Psychosocial Health Symptoms in Cancer Patients and Survivors: A Systematic Review

“…Seven studies involved interventions examining the effects of probiotics, [38][39][40][41]44,46,48 3 investigated prebiotics, 42,43,45 and 2 studies used a combination of prebiotics and probiotics, referred to as a synbiotic. 37,47 As seen in Table 1, treatment duration varied from 2 to 24 weeks.…”

“…As seen in Table 1, among interventions using probiotics [38][39][40][41]44,46,48 or synbiotics, 37,47 various probiotic strains and doses were used. The most consistently used probiotic strains belonged to the Lactobacillus genus (100%), [37][38][39][40][41]44,[46][47][48] followed by those from the Bifidobacterium genus (56%). 37,38,40,44,46 Doses and treatment duration varied from one study to the next, with minimal consistency observed between studies.…”

“…As seen in Figure 2, probiotic treatment was found to significantly improve several GI and some psychosocial health outcomes (ie, QOL) in cancer patients and survivors. In total, 11 studies investigated the effects of a prebiotic, 42,43 probiotic, [38][39][40][41]44,46,48 or synbiotic 37,47 treatment on GI outcomes. As seen in Table 1, a variety of measures were used to evaluate GI symptoms.…”