Table 2.
Use of probiotics, prebiotics, and synbiotics in AP.
| Studies | Subjects | Pre/Pro/Synbiotics | Main Effect of Treatment Group |
|---|---|---|---|
| Oláh 2002 [74] | 45 AP | Live L. plantarum 299, together with a substrate of oat fiber | Pancreatic sepsis ↓ Number of surgical interventions ↓ |
| Oláh 2007 [75] | 62 SAP | Four different lactobacilli preparations and prebiotics containing four bioactive fibers (inulin, beta-glucan, resistant starch, and pectin) | Incidence SIRS and MOF ↓ Rate of late (over 48 h) organ failure ↓ |
| Karakan 2007 [73] | 30 SAP | Standard enteral nutrition with soluble and insoluble fibers | Hospital stay ↓ APACHE II, CRP, and CT store normalization duration ↓ Overall complications ↓ |
| Besselink 2008 [76] | 298 predicted SAP | Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus salivarius, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis | Risk of mortality ↑ |
| Lata 2010 [86] | 22 AP | B. bifidum, B. infantis, L. acidophilus, L. casei, L. salivarius, L. lactis | Endotoxin levels ↓ |
| Sharma 2011 [82] | 50 AP | Lactobacillus acidophilus, Bifidobacterium longus, Bifidobacterium bifidum, and Bifidobacterium infantalis with fructo-oligosaccharide | CRP and immunoglobulins ↓ |
| Plaudis 2012 [87] | 90 SAP | Synbiotic 2000 Forte | Infection rate (pancreatic and peripancreatic necrosis) ↓ Rate of surgical interventions ↓ ICU and hospital stay ↓ Mortality rate ↓ |
| Cui 2013 [81] | 70 SAP | Bifidobacterium | Pro-inflammatory cytokines ↓ Earlier restoration of gastrointestinal function Complications ↓ Hospital day ↓ |
| Wang 2013 [88] | 183 SAP | Live Bacillus subtilis and Enterococcus faecium | Percentage of pancreatic sepsis and MODS ↓ Mortality rate ↓ Pro-inflammatory cytokines and APACHE II scores ↓ Plasma concentration of IL-10 ↑ |
| Zhu 2014 [89] | 39 SAP | C. Butyricum | Rate of intestinal ischemia and necrosis ↑ |
| Li 2014 [90] | 80 SAP | Bifidobacterium | Pro-inflammatory cytokines levels ↓ CRP and LDH levels ↓ Mortality and incidence of complications ↓ Duration of hospitalization ↓ |
| Wu 2017 [91] | 120 SAP | Live B. bifidus, B. acidophilus, E. faecalis, and B. cereus | Incidence of infection MODS ↓ Duration of abdomen pain and hospitalization ↓ |
| Fang 2018 [92] | 68 SAP | Live Bifidobacterium, Lactobacillus, and Enterococcus | Relieved clinical symptoms Hospitalization time ↓ Serum inflammatory cytokine levels ↓ |
| Wang 2023 [84] | 73 MSAP | Lactulose | Serum levels of cytokines ↓ Gut permeability index ↓ Bifidobacterium ↑ Level of SCFAs ↑ |
| Rohith 2023 [85] | 86 MSAP or SAP | Synbiotics containing Streptococcus faecalis T-110, Clostridium butyricum TO-A, Bacillus mesentricus TO-A, and Lactobacillus sporogenes | Total leucocyte and neutrophil counts ↓ Length of hospitalization ↓ |
AP, acute pancreatitis; MSAP, moderately severe acute pancreatitis; SAP, severe acute pancreatitis; SIRS, systemic inflammatory response syndrome; MOF, multi-organ failure; MODS, multiple organ dysfunction syndrome; APACHE II, Acute Physiology and Chronic Health Evaluation II; IL, interleukin; CRP, C-reactive protein; ICU, intensive care unit; CT, computed tomography; LDH, lactate dehydrogenase; SCFAs, short chain fatty acids. The arrows indicate the changes of main outcomes after the treatment of probiotics, prebiotics, or synbiotics.