Mark C van Baal1, Michiel J van Rens2, Christopher B Geven2, Francien M van de Pol3, Ilona W van den Brink3, Gerjon Hannink2, Iris D Nagtegaal4, Wilbert H Peters5, Ger T Rijkers2, Hein G Gooszen6. 1. Dept. Operating Rooms/Evidence Based Surgery, Radboudumc, Nijmegen, The Netherlands. Electronic address: markvanbaal@gmail.com. 2. Dept. Operating Rooms/Evidence Based Surgery, Radboudumc, Nijmegen, The Netherlands. 3. Dept. of Anesthesiology, Radboudumc, Nijmegen, The Netherlands. 4. Dept. of Pathology, Radboudumc, Nijmegen, The Netherlands. 5. Dept. of Gastroenterology, Radboudumc, Nijmegen, The Netherlands. 6. Dept. Operating Rooms/Evidence Based Surgery, Radboudumc, Nijmegen, The Netherlands. Electronic address: hein.gooszen@radboudumc.nl.
Abstract
BACKGROUND/ OBJECTIVES: Recently, a randomized controlled trial showed that probiotic prophylaxis was associated with an increased mortality in enterally fed patients with predicted severe pancreatitis. In a rat model for acute pancreatitis, we investigated whether an association between probiotic prophylaxis and enteral nutrition contributed to the higher mortality rate. METHODS: Male Sprague-Dawley rats were allocated to four groups: 1) acute pancreatitis (n = 9), 2) acute pancreatitis and probiotic prophylaxis (n = 10), 3) acute pancreatitis and enteral nutrition (n = 10), and 4) acute pancreatitis, probiotic prophylaxis and enteral nutrition (n = 11). Acute pancreatitis was induced by intraductal glycodeoxycholate and intravenous cerulein infusion. Enteral nutrition, saline, probiotics and placebo were administered through a permanent jejunal feeding. Probiotics or placebo were administered starting 4 days before induction of pancreatitis and enteral nutrition 1 day before start until the end of the experiment, 6 days after induction of pancreatitis. Tissue samples and body fluids were collected for microbiological and histological examination. RESULTS: In all animals, serum amylase was increased six hours after induction of pancreatitis. After fulfilling the experiment, no differences between groups were found in histological severity of pancreatitis, degree of discomfort, weight loss, histological examination of small bowel and bacterial translocation (all p > 0.05). Overall mortality was 10% without differences between groups (p = 0.54). CONCLUSION: No negative association was found between prophylactic probiotics and enteral nutrition in acute pancreatitis. No new clues for a potential mechanism responsible for the higher mortality and bowel ischaemia in the PROPATRIA study were found.
BACKGROUND/ OBJECTIVES: Recently, a randomized controlled trial showed that probiotic prophylaxis was associated with an increased mortality in enterally fed patients with predicted severe pancreatitis. In a rat model for acute pancreatitis, we investigated whether an association between probiotic prophylaxis and enteral nutrition contributed to the higher mortality rate. METHODS: Male Sprague-Dawley rats were allocated to four groups: 1) acute pancreatitis (n = 9), 2) acute pancreatitis and probiotic prophylaxis (n = 10), 3) acute pancreatitis and enteral nutrition (n = 10), and 4) acute pancreatitis, probiotic prophylaxis and enteral nutrition (n = 11). Acute pancreatitis was induced by intraductal glycodeoxycholate and intravenous cerulein infusion. Enteral nutrition, saline, probiotics and placebo were administered through a permanent jejunal feeding. Probiotics or placebo were administered starting 4 days before induction of pancreatitis and enteral nutrition 1 day before start until the end of the experiment, 6 days after induction of pancreatitis. Tissue samples and body fluids were collected for microbiological and histological examination. RESULTS: In all animals, serum amylase was increased six hours after induction of pancreatitis. After fulfilling the experiment, no differences between groups were found in histological severity of pancreatitis, degree of discomfort, weight loss, histological examination of small bowel and bacterial translocation (all p > 0.05). Overall mortality was 10% without differences between groups (p = 0.54). CONCLUSION: No negative association was found between prophylactic probiotics and enteral nutrition in acute pancreatitis. No new clues for a potential mechanism responsible for the higher mortality and bowel ischaemia in the PROPATRIA study were found.
Authors: Tommaso Schepis; Sara S De Lucia; Enrico C Nista; Vittoria Manilla; Giulia Pignataro; Veronica Ojetti; Andrea Piccioni; Antonio Gasbarrini; Francesco Franceschi; Marcello Candelli Journal: J Clin Med Date: 2021-12-17 Impact factor: 4.241