The role of probiotics and prebiotics in the treatment of pancreatitis

Acute pancreatitis is a potentially fatal condition, and its incidence is increasing. Bacterial translocation and end organ failure are the main causes of death. Gut flora have the potential for modulation of the inflammatory cascade. Fasting has a negative impact on gut flora. Animal studies suggested a role for probiotics in the treatment of severe acute pancreatitis; however, a very recent human trial showed disappointing results. Symbiotic combinations have shown variable results in the treatment of severe acute pancreatitis. Prebiotics alone are not thoroughly studied in severe acute pancreatitis. Only 1 study has shown positive results, and further studies are needed. Although probiotics are contraindicated in severe acute pancreatitis according to a recent multicenter study, strain-specific properties of probiotics should urgently be investigated, and further well-designed trials are badly needed. (Nutritional Therapy & Metabolism 2010; 28: 1-6)