Probiotics should probably not be used in patients with predicted severe acute pancreatitis, according to the results of a randomised, double-blind, placebo-controlled trial.1 Within 72 hours of symptom onset, 298 people with predicted severe acute pancreatitis were randomly assigned to receive an enterically administered probiotic preparation or a placebo for 28 days. Although there was no significant difference in the rate of infectious complications between the two groups, nine patients in the probiotic group developed bowel ischaemia (compared with none in the control group) and 24 died (compared with nine in the control group). These results appear to be at odds with the published literature, which has not shown an increase in mortality with the use of probiotics. The authors speculate that the bowel ischaemia may have been a side effect of increased bacterial load, leading to inflammation and a reduction in capillary blood flow.
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