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Langenbeck's Archives of Surgery

, Volume 394, Issue 1, pp 191–192 | Cite as

New randomized trial of probiotics in pancreatitis needed? Caution advised

  • Marc G. H. Besselink
  • Hjalmar C. van Santvoort
  • Geert J. M. G. van der Heijden
  • Erik Buskens
  • H. G. Gooszen
  • For the Dutch Acute Pancreatitis Study Group
Letter to the Editor

Dear Sir,

We support the use of large-scale, high-quality, placebo-controlled randomized trials as much as Dr. Sun and co-workers do [1]. However, we do not support their rather strong conclusion that a new randomized trial of probiotic prophylaxis in patients with predicted severe acute pancreatitis is currently warranted.

In their meta-analysis, Sun et al. detected no significant effects of probiotic prophylaxis in patients with acute pancreatitis [1]. In our double-blind study on the effect of combined probiotic strains, which had a sample size almost five times larger than the previous studies, we detected a significant increase in both mortality and bowel ischemia [2]. These were all well-reputed probiotic strains that had been used for a long time without any negative effects being reported. The major difference between our study and the previous three studies is the much larger number of patients with concurrent organ failure. In their studies, Olah et al. included only four...

Keywords

Pancreatitis Acute Pancreatitis Organ Failure Systemic Inflammatory Response Syndrome Severe Acute Pancreatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Sun S, Yang K, He X, Tian J, Ma B, Jiang L (2008) Probiotics in patients with severe acute pancreatitis: a meta-analysis. Langenbecks Arch Surg. doi: 10.1007/s00423-008-0379-2
  2. 2.
    Besselink MG, Van Santvoort HC, Buskens E et al (2008) Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 371:651–659. doi: 10.1016/S0140-6736(08)60207-X PubMedCrossRefGoogle Scholar
  3. 3.
    Olah A, Belagyi T, Issekutz A et al (2002) Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis. Br J Surg 89:1103–1107. doi: 10.1046/j.1365-2168.2002.02189.x PubMedCrossRefGoogle Scholar
  4. 4.
    Olah A, Belagyi T, Poto L et al (2007) Synbiotic control of inflammation and infection in severe acute pancreatitis: a prospective, randomized, double blind study. Hepatogastroenterology 54:590–594PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Marc G. H. Besselink
    • 1
  • Hjalmar C. van Santvoort
    • 1
  • Geert J. M. G. van der Heijden
    • 2
  • Erik Buskens
    • 3
  • H. G. Gooszen
    • 1
  • For the Dutch Acute Pancreatitis Study Group
  1. 1.Department of SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Department of EpidemiologyUniversity Medical Center GroningenGroningenThe Netherlands

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