Is probiotic prophylaxis worthwhile in patients with predicted severe acute pancreatitis?

Few studies have examined probiotic prophylaxis in patients with acute pancreatitis, and those that have been performed have yielded conflicting results. In this Practice Point commentary, I discuss the findings and limitations of a study by Besselink et al., which assessed the effects of a multispecies probiotic preparation in patients with predicted severe acute pancreatitis. The preparation did not reduce infectious complications, and increased mortality. However, it is necessary to remember that large genetic and functional differences exist between various strains of bacteria and that only a few lactic acid bacteria ( LAB) have demonstrated an ability to significantly reduce inflammation, control infection and provide health benefits to humans. Choice of LAB and dose of LAB is critical for outcome. Extensive preclinical studies are essential before recommendations for new cocktails of probiotics can be introduced in clinical practice.