Modification of intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis

doi:10.1016/j.surg.2006.10.007

Surgery

Volume 141, Issue 4, April 2007, Pages 470-480

Part of this work was presented at the 13th United European Gastroenterology Week (Copenhagen, Denmark) and was published as an abstract (Gut 2005; suppl VII (54):A24).

https://doi.org/10.1016/j.surg.2006.10.007 Get rights and content

Background

Infection of pancreatic necrosis by gut bacteria is a major cause of morbidity and mortality in patients with severe acute pancreatitis. Use of prophylactic antibiotics remains controversial. The aim of this experiment was assess if modification of intestinal flora with specifically designed multispecies probiotics reduces bacterial translocation or improves outcome in a rat model of acute pancreatitis.

Methods

Male Sprague-Dawley rats were allocated into 3 groups: (1) controls (sham-operated, no treatment), (2) pancreatitis and placebo, and (3) pancreatitis and probiotics. Acute pancreatitis was induced by intraductal glycodeoxycholate and intravenous cerulein infusion. Daily probiotics or placebo was administered intragastrically from 5 days prior until 7 days after induction of pancreatitis. Tissue and fluid samples were collected for microbiologic and quantitative real-time PCR analysis of bacterial translocation.

Results

Probiotics reduced duodenal bacterial overgrowth of potential pathogens (Log₁₀ colony-forming units [CFU]/g 5.0 ± 0.7 [placebo] vs 3.5 ± 0.3 CFU/g [probiotics], P < .05), resulting in reduced bacterial translocation to extraintestinal sites, including the pancreas (5.38 ± 1.0 CFU/g [placebo] vs 3.1 ± 0.5 CFU/g [probiotics], P < .05). Accordingly, health scores were better and late phase mortality was reduced: 27% (4/15, placebo) versus 0% (0/13, probiotics), respectively, P < .05.

Conclusions

This experiment supports the hypothesis that modification of intestinal flora with multispecies probiotics results in reduced bacterial translocation, morbidity, and mortality in the course of experimental acute pancreatitis.

Section snippets

Animals

Male, pathogen-free Sprague-Dawley rats, 250 to 350 grams, (Harlan, Horst, The Netherlands) were kept under constant housing conditions (temperature, 22°C; relative humidity, 60%; and a 12-hour light/dark cycle) and had free access to water and food (RMH 1110, Hope Farms, Woerden, The Netherlands) throughout the experiment. Rats were allowed to adjust to these conditions for 1 week prior to surgery. The experimental design shown in Fig 1 was approved by the institutional animal care committee

Morbidity and mortality

After the start of daily placebo or probiotic administrations, physical behavior of all rats remained normal, resulting in maximal health scores from day -5 until day 0. The clinical response of the rats after induction of experimental pancreatitis followed a biphasic course. During the first 72 hours, the animals exhibited decreased grooming or motility and, to some extent, behavior associated with pain, despite analgesic administration during the first 48 hours. From days 3 to 5, surviving

Discussion

This is the first study to assess the potential of a specifically designed multispecies probiotic mixture to reduce bacterial translocation during acute pancreatitis. In this paper, we demonstrate that modification of intestinal flora with this probiotic mixture alters the course of experimental acute pancreatitis. Administration of the selected probiotic mixture resulted in the following: (1) reduced duodenal overgrowth of pathogens, such as E. coli; (2) reduced bacterial translocation to

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: Supported in part by Astra Zeneca, Research & Development, Mölndal, Sweden (L.P.M.); Winclove Bio Industries B.V., Amsterdam, The Netherlands (H.M.T.); and Senter, an agency of the Dutch Ministry of Economic Affairs (grant number: TSGE3109). Supporting institutions were not involved in design, performance or publication of this study.

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Original communicationModification of intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis

Background

Methods

Results

Conclusions

Section snippets

Animals

Morbidity and mortality

Discussion

Pancreatology

Pancreatology

J Am Coll Surg

Int J Food Microbiol

Trends Microbiol

J Gastrointest Surg

J Surg Res

Physiol Behav

Gastroenterology

Surgery

J Crit Care

Pancreatology

Gastroenterology

Acute necrotizing pancreatitis: treatment strategy according to the status of infection

Ann Surg

Pancreatic infection complicating acute pancreatitis

Br J Surg

Natural course of acute pancreatitis

World J Surg

Meta-analysis of prophylactic antibiotic use in acute necrotizing pancreatitis

Br J Surg

Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality

Crit Care Med

Characteristics of infection with Candida species in patients with necrotizing pancreatitis

World J Surg

Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy

Clin Infect Dis

Emergence of antibiotic resistance in infected pancreatic necrosis

Arch Surg

Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis

Br J Surg

Prevention of infectious complications in surgical patients: potential role of probiotics

Dig Surg

Lactobacillus plantarum reduces infection of pancreatic necrosis in experimental acute pancreatitis

Dig Surg

Role of probiotics in food hypersensitivity

Curr Opin Allergy Clin Immunol

Interdigestive small bowel motility and duodenal bacterial overgrowth in experimental acute pancreatitis

Neurogastroenterol Motil

T lymphocytes in host defense against bacterial translocation from the gastrointestinal tract

Infect Immun

Bacterial translocation from the gastrointestinal tract

Adv Exp Med Biol

Multisystemic production of interleukin 10 limits the severity of acute pancreatitis in mice

Gut

Original communication
Modification of intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis