Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials

Gou, Shanmiao; Yang, Zhiyong; Liu, Tao; Wu, Heshui; Wang, Chunyou

doi:10.1186/cc13809

Cited by 90 publications

(67 citation statements)

References 53 publications

(69 reference statements)

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“…Our data have provided further support for the latter recommendation since there was no difference seen in severity and mortality between groups who received preventive and therapeutic antibiotic treatments. Meta-analyses have shown that probiotics have neither beneficial nor adverse effects in the outcome of AP [40]. Our doctors generally followed recommendation F19 in the IAP/APA guidelines.…”

Section: Discussionmentioning

confidence: 99%

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

et al. 2016

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ObjectiveThe aim of this study was to analyse the clinical characteristics of acute pancreatitis (AP) in a prospectively collected, large, multicentre cohort and to validate the major recommendations in the IAP/APA evidence-based guidelines for the management of AP.DesignEighty-six different clinical parameters were collected using an electronic clinical research form designed by the Hungarian Pancreatic Study Group.Patients600 adult patients diagnosed with AP were prospectively enrolled from 17 Hungarian centres over a two-year period from 1 January 2013.Main ResultsWith respect to aetiology, biliary and alcoholic pancreatitis represented the two most common forms of AP. The prevalence of biliary AP was higher in women, whereas alcoholic AP was more common in men. Hyperlipidaemia was a risk factor for severity, lack of serum enzyme elevation posed a risk for severe AP, and lack of abdominal pain at admission demonstrated a risk for mortality. Abdominal tenderness developed in all the patients with severe AP, while lack of abdominal tenderness was a favourable sign for mortality. Importantly, lung injury at admission was associated with mortality. With regard to laboratory parameters, white blood cell count and CRP were the two most sensitive indicators for severe AP. The most common local complication was peripancreatic fluid, whereas the most common distant organ failure in severe AP was lung injury. Deviation from the recommendations in the IAP/APA evidence-based guidelines on fluid replacement, enteral nutrition and timing of interventions increased severity and mortality.ConclusionsAnalysis of a large, nationwide, prospective cohort of AP cases allowed for the identification of important determinants of severity and mortality. Evidence-based guidelines should be observed rigorously to improve outcomes in AP.

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Section: Discussionmentioning

confidence: 99%

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

et al. 2016

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“…In a recent systematic review and meta-analysis of six heterogeneous RCTs, Gou et al . reported that probiotics did not reduce pancreatic infection rates, hospital LOS, or mortality 70 .…”

Section: Recent Advances In Early Treatment Of Acute Pancreatitismentioning

confidence: 98%

Recent advances in understanding and managing acute pancreatitis

Mandalia¹,

Wamsteker²,

DiMagno³

2018

F1000Res

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This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS). In severe AP, a multidisciplinary approach is warranted to minimize morbidity and mortality over the course of a protracted hospital LOS. Based on evidence from guideline recommendations, we discuss five treatment interventions, including intravenous fluid resuscitation, feeding, prophylactic antibiotics, probiotics, and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis. This review also highlights the importance of preventive interventions to reduce hospital readmission or prevent pancreatitis, including alcohol and smoking cessation, same-admission cholecystectomy for acute biliary pancreatitis, and chemoprevention and fluid administration for post-ERCP pancreatitis. Our review aims to consolidate guideline recommendations and high-quality studies published in recent years to guide the management of AP and highlight areas in need of research.

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“…В рандомизированном двой-ном слепом плацебо-контролируемом исследовании при назначении пациентам с тяжелым панкреатитом полипробиотического препарата, включающего L. casei, L. salivarius, L. lactis, B. bifidum и B. lactis, показано значительное повышение летальных случаев и случаев развития ишемии кишечника в группах больных, по-лучавших пробиотики (24 против 9, р=0,01 и 9 про-тив 0, р=0004 соответственно). Сделан вывод о том, что при остром панкреатите применение указанного выше набора пробиотиков нецелесообразно и опас-но в связи с развитием тяжелых осложнений [62]. При этом следует подчеркнуть, что ни в зарубежных, ни в отечественных источниках литературы нет сооб-щений о возникновении ассоциированного с бифи-добактериями сепсиса, что свидетельствует о неспо-собности проявления патогенных свойств бактериями данного рода [63,64].…”

Section: обзоры литературыunclassified

Probiotics in pediatrics: Pros and cons in the context of evidence-based medicine

Мазанкова¹,

Rybalchenko²,

Корниенко³

et al. 2016

Ross. vestn. perinatol. pediatr.

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Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials

Cited by 90 publications

References 53 publications

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis

Recent advances in understanding and managing acute pancreatitis

Probiotics in pediatrics: Pros and cons in the context of evidence-based medicine

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