Researchers at Chongqing University conducted a meta-analysis to ascertain the value of pre-, pro- and synbiotic supplementation as part of standard enteral nutrition for SAP patients, using a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials.
Significance…or a lack thereof
They settled on 13 RCTs that compared the effects of pre-, pro- and synbiotics added to standard enteral nutrition against control in a total of 950 SAP patients.
According to the pooled results, combined supplementation of pre-, pro- and synbiotics was able to help shorten the length of SAP patients' hospital stay in Chinese cohorts.
Apart from that, however, significant differences were not observed for all patients in terms of other clinical outcomes.
For instance, 10 of the 13 studies reviewed reported infected pancreatic necrosis in the SAP patients, on whom pre-, pro- and synbiotic supplementation had minimal, statistically insignificant effects.
Likewise, while the mortality rate in the treatment groups showed a "promising trend" compared to that in the control groups, the difference was statistically insignificant.
When it came to systemic inflammatory response syndrome (SIRS), organ failure, and other infectious complications such as chest infection, urinary tract infection and septic morbidity, there was also no statistically significant difference between the treatment and control groups.
However, the researchers also outlined the study's limitations, including a lack of focus on a specific treatment — previous studies had targeted probiotics instead of pre-, pro- and synbiotics.
They also did not perform subgroup analysis based on the strain of probiotic bacteria, owing to a unavailable information on single strains in most of the reviewed trials.
Furthermore, they did not investigate the effects of treatment duration on overall impact and safety, as three of the studies did not clearly report the time of intervention.
This was important, as prolonged treatment duration might actually be detrimental to SAP patients who suffer from intestinal barrier dysfunction.
The researchers had also gotten different results in the area of total infection, following regional subgroup analysis — while Chinese SAP patients benefited from the supplementation, Western patients did not.
In addition, the treatment groups' shortened hospital stays were limited to publications on Chinese cohorts, with pooled results from Chinese and Western SAP patients being inconsistent. The researchers hypothesised that an inadequate sample size was "the important contributor to the difference".
They then concluded: "Although the accumulated sample size of 950 was still not sufficient, the present pooled results still indicated that pre-, pro-, or synbiotics, in a manner, shorten the length of hospital stay in Chinese SAP patients.
"Moreover, the findings from our study also indicated a promising trend which was beneficial to pre-, pro- or synbiotics with regards to most of the other clinical outcomes, such as infected pancreatic necrosis and mortality. Thus, we concluded that pre-, pro-, or synbiotics may have potential for the treatment of SAP.
"Nevertheless, it is essential to design RCTs with a large-scale and appropriate blinded method to further establish the efficacy and safety of pre-, pro- or synbiotics in SAP before making recommendations, due to the presence of limitations.
"Moreover, more experimental studies should also be designed in order to deeply explore the mechanisms of pre-, pro- or synbiotics in SAP."
Source: Frontiers in Pharmacology
"Supplemented Use of Pre-, Pro-, and Synbiotics in Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis of 13 Randomized Controlled Trials"
Authors: Xu Tian, et al.