Efficacy of pre, pro, and synbiotic on clinical endpoint of acute pancreatitis: a systematic review and meta-analysis

Abstract

Background: Acute pancreatitis (AP) commonly presents as gastrointestinal disease and can become a life-threatening condition. The pathophysiological process involves impairment in the gut barrier and bacterial translocation, mediating the infection of necrotic pancreatic tissue. Therefore, a strategy to maintain gut integrity is rational. The Probiotics in Pancreatitis Trial (PROPATRIA) found that probiotics had a harmful effect on severe AP. However, additional research revealed neither favorable nor unfavorable effects. This study aimed to analyze the efficacy of these medications on clinical endpoints in patients with AP. Methods: We performed a systematic search up to April 14, 2023. The study population in this review were patients with AP. The intervention consisted of prebiotic group, probiotic group, and synbiotic group. The effectiveness of each group in treating LoH was the main result, while infection complications were the secondary result. The analysis was conducted using a random effect model, and publication bias was found using a funnel plot. Results: 16 studies were used in this review and meta-analysis. A total of 1,044 acute pancreatitis patients and 779 patients were included for primary and secondary outcomes, respectively. The use of either pre-, pro-, and synbiotics reduces the LoH significantly (-3.32 days, p = 0.001). Subgroup analysis of the interventions revealed that probiotics (-3.02 days, p =0.02) and prebiotics (-3.9 days, p =0.02) reduce the LoH, but not for synbiotics (-4.37 days, p =0.18). As for secondary outcomes, the use of pre-, pro-, and synbiotics reduce the risk of infection in acute pancreatitis patients with odds ratio (OR) of 0.32 (p = 0.006). Conclusion: Additional medication of prebiotics, probiotics, and synbiotics as an adjunctive to standard therapy showed clinical benefits in AP patients. Therefore, its usage on acute pancreatitis patients could provide clinical benefit, albeit further studies are warranted.