Randomised clinical trial of synbiotic therapy in elective surgical patients

Abstract

Background: It is possible to manipulate the composition of the gastrointestinal microflora by administration of pre-and probiotics. This may help to preserve gut barrier function and reduce the incidence of septic morbidity. Aims: To assess the effects of a combination of pre-and probiotics (synbiotic) on bacterial translocation, gastric colonisation, systemic inflammation, and septic morbidity in elective surgical patients. Patients: Patients were enrolled two weeks prior to elective abdominal surgery. Seventy two patients were randomised to the synbiotic group and 65 to the placebo group. Patients were well matched regarding age and sex distribution, diagnoses, and POSSUM scores. Methods: Patients in the synbiotic group received a two week preoperative course of Lactobacillus acidophilus La5, Bifidobacterium lactis Bb-12, Streptococcus thermophilus, and Lactobacillus bulgaricus, together with the prebiotic oligofructose. Patients in the placebo group received placebo capsules and sucrose powder. At surgery, a nasogastric aspirate, mesenteric lymph node, and scrapings of the terminal ileum were harvested for microbiological analysis. Serum was collected preoperatively and on postoperative days 1 and 7 for measurement of C reactive protein, interleukin 6, and antiendotoxin antibodies. Septic morbidity and mortality were recorded. Results: There were no significant differences between the synbiotic and control groups in bacterial translocation (12.1% v 10.7%; p = 0.808, x 2 ), gastric colonisation (41% v 44%; p = 0.719), systemic inflammation, or septic complications (32% v 31%; p = 0.882). Conclusions: In this study, synbiotics had no measurable effect on gut barrier function in elective surgical patients. Further studies investigating the place of pre-and probiotics in clinical practice are required.

Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials

“…From the remaining 11 RCTs, three were excluded: one article was a letter to the editor concerning an already published RCT, one focused on the combination of preoperative and postoperative use of probiotics versus postoperative use of probiotics [17], and one was an animal study. Thus, nine RCTs ultimately qualified for inclusion in our study [18][19][20][21][22][23][24][25][26].…”

“…The food supplements containing both probiotics and prebiotics are called synbiotics [16]. Several randomized controlled trials (RCTs) using probiotics/synbiotics preoperative and/or postoperative with a focus on the prevention of postoperative infections [17][18][19][20][21][22][23][24][25][26] have been performed, and a narrative review has been published [27].…”

Prebiotics in Chronic Intestinal Inflammation

“…However, increased bacterial translocation was not found in synbiotic-treated patients (n = 72) compared to placebo-treated patients in elective surgery patients. 72 Taken together, the effects of prebiotics on bacterial translocation are still unclear and further research is necessary. …”

Probiotics and prebiotics — renaissance of a therapeutic principle

“…The administration of the synbiotic favorably altered the microbial spectrum of the small intestine but did not affect the intestinal permeability and no clinical benefit was observed. The same authors described negative results with the preventive application of probiotics and oligofructose to patients before elective abdominal surgery [179]. On the other hand, Rayes et al [180] reported significant decrease of postoperative bacterial infections and a shorter period of antibiotic administration after orthotopic liver transplantation in subjects with immediate postoperative enteral nutrition including a synbiotic (lactobacilli and oligofructose).…”