Use of pre-, pro- and synbiotics in patients with acute pancreatitis: A meta-analysis

Table 1 Methodological characteristics of the clinical trials included in this meta-analysis

Trial	Patients (synbiotics/control)	Characteristics of patients (synbiotics/control)	Intervention	Control group	Length of treatment (d)
Oláh et al[16] (UK, 2002)	45 (22/23)	Mean Glasgow score (2.5/2.8), mean CRP (206.5/188.7) mg/L	109L. plantarum 299 + EN + 10 g oat fiber	EN + heat-killed L. plantarum 299 + oat fiber	7
Oláh et al[17] (UK, 2007)	62 (33/29)	Mean Imrie score (2.9/3.1), mean CRP (216.7/191.2) mg/L	Four LAB: 1010P. pentosaceus, Leuconostoc mesenteroides, L. paracasei and L. plantarum + four bioactive fiber (Synbiotics 2000) + EN	EN + four bioactive fiber	7
Karakan et al[25] (Turkey, 2007)	30 (15/15)	Mean APACHE II score (9.4/9.6), mean CRP (232/244) mg/L	24 g multi-fibers including soluble fibers and insoluble fibers + EN	EN	6-13
Qin et al[18] (China, 2008)	74 (36/38)	Mean APACHE II score (8.8/8.9), mean CRP (125/136) mg/L	108L. plantarum + EN + PN	PN	7
Besselink et al[19] (Netherlands, 2008)	296 (152/144)	Mean APACHE II score (8.6/8.4), mean Imrie score (3.3/3.4), mean CRP (268/270) mg/L	Six LAB: 1010L. acidophilus, L. casei, L. salivarius, L.lactis, B. bifidum, and B. lactis (Ecologic 641) + cornstarch + maltodextrins + fiber-riched EN	Cornstarch + maltodextrins + fiber-riched EN	28
Li et al[26] (China, 2007)	25 (14/11)	APACHE II score 8-20	Three LAB:7.2 × 107B. longum, L. bulgaricus and S. thermophilus (Golden Bifid)	Water	7
Wu et al[27] (China, 2009)	27 (14/13)	APACHE II score 8-20	Three strains: > 6 × 104L. lactis + L. acidophilus and S. lactis	N/A	7

N/A: Not applicable; APACHE II: Score of the second acute physiology and chronic health evaluation; CRP: C-reactive protein; LAB: Lactic acid bacteria; L.: Lactobacillus; B.: Bifidobacterium; E.: Enterococcus; P.: Pediococcus; S.: Streptococcus; EN: Enteral nutrition; PN: Parenteral nutrition.

Table 2 Surgical outcomes from randomized studies included in this meta-analysis

Trial	No. of patients	Septic morbidity (%)	MOF (%)	SIRS (%)	Pancreatic infections (%)	Surgical interventions (%)	Hospital stay (d)	Mortality (%)
Oláh et al[16]	22/23	5 (22.7)/ 20 (87)	2 (9.1)/ 2 (8.7)	11 (50)/ 6 (26.1)	1 (4.5)/ 7 (30.4)	1 (4.5)/ 7 (30.4)	13.7/21.4 (median)	1 (4.5)/2 (8.7)
Oláh et al[17]	33/29	9 (27.3)/ 15 (51.7)	5 (15.1)/ 9 (31)	3 (9)/ 5 (17.2)	4 (12.1)/ 8 (27.6)	4 (12.1)/ 7 (24.1)	14.9/19.7 (median)	2 (6.1)/6 (20.7)
Karakan et al[25]	15/15	2 (13.3)/ 2 (13.3)	1 (6.7)/ 2 (13.3)	N/A	N/A	N/A	10 ± 4/15 ± 6	2 (13.3)/4 (26.7)
Qin et al[18]	36/38	11 (30.6)/ 29 (76.3)	4 (11.1)/ 7 (18.4)	6 (16.7)/ 14 (36.8)	N/A	N/A	20.9/24.2 (median)	0 (0)/0 (0)
Besselink et al[19]	152/144	46 (30.3)/ 41 (28.47)	33 (22)/ 15 (10)	N/A	21 (14)/ 14 (10)	28 (18)/ 14 (10)	28.9 ± 41.5/23.5 ± 25.9	24 (16)/9 (6)
Li et al[26]	14/11	N/A	N/A	N/A	N/A	N/A	42 ± 5/49 ± 6.8	N/A
Wu et al[27]	14/13	N/A	N/A	N/A	N/A	N/A	34 ± 6/40 ± 6	5 (35.7)/6 (46.2)

N/A: Not applicable; MOF: Multi-organ failure; SIRS: Systemic inflammatory response syndrome.

Table 3 Quality assessment of the included randomized trials

Trial	Generation of random	Allocation concealment	Blinding	Follow-up	Baseline similarity	Jadad score
Oláh et al[16]	Unclear	Unclear	Double blinded	No	Similar	4
Oláh et al[17]	Unclear	Adequate	Double blinded	No	Similar	4
Karakan et al[25]	Clear	Adequate	Double blinded	No	Similar	3
Qin et al[18]	Clear	Unclear	No blinding	Yes	Similar	3
Besselink et al[19]	Clear	Adequate	Double blinded	Yes	Similar	5
Li et al[26]	Unclear	Unclear	No blinding	No	Similar	1
Wu et al[27]	Unclear	Unclear	No blinding	No	Similar	1

Table 4 Surgical outcomes stratified by severity of pancreatitis in this meta-analysis

	No. of studies	Synbiotic	Control	OR (95% CI)	P for effect size	P for heterogeneity
Septic morbidity	3	57/200	58/188	0.89 (0.57, 1.37)	0.58	0.16
Pancreatic infections	2	25/185	22/173	1.06 (0.58, 1.96)	0.84	0.07
Surgical intervention	2	32/185	21/173	1.07 (0.23, 4.92)	0.94	0.04
MOF and SIRS	3	43/200	36/188	0.65 (0.09, 4.44)	0.66	0.0005
Mortality	4	33/214	25/201	0.77 (0.22, 2.72)	0.69	0.02

OR: Odds ratio; CI: Confidence interval; MOF: Multi-organ failure; SIRS: Systemic inflammatory response syndrome.