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A reassessment of the PROPATRIA study and its implications for probiotic therapy

Ger P A Bongaerts1, René S V M Severijnen2

  • 1Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.

Nature Biotechnology
|January 9, 2016
PubMed

Insights

The PROPATRIA trial found a higher mortality rate in severe acute pancreatitis patients receiving probiotics. This suggests a potential interaction between probiotics, pancreatic enzymes, and lactic acid, necessitating careful consideration in future research.

Area of Science:

  • Gastroenterology
  • Clinical Nutrition
  • Microbiology

Background:

  • Severe acute pancreatitis carries significant risks of infectious complications.
  • Enteral probiotics have been explored to mitigate these complications.
  • Previous studies suggested potential benefits of probiotics in related conditions.

Purpose of the Study:

  • To evaluate the efficacy of a multispecies probiotic preparation in reducing infectious complications in severe acute pancreatitis.
  • To investigate the safety and impact of probiotic therapy in this patient population.

Main Methods:

  • A multicenter, double-blind, placebo-controlled clinical trial (PROPATRIA).
  • Patients with predicted severe acute pancreatitis received either a probiotic preparation or placebo enterally.
  • Mortality rates and infectious complications were monitored.

Main Results:

  • The probiotic group experienced a significantly higher mortality rate (16%) compared to the placebo group (6%).
  • This contrasts with previous findings and suggests a potential adverse interaction.
  • Elevated lactic acid levels, possibly from bacterial fermentation, were implicated.

Conclusions:

  • Probiotic therapy in severe acute pancreatitis, as conducted in PROPATRIA, may be associated with increased mortality.
  • A lethal combination of pancreatic enzymes and probiotics, exacerbated by lactic acid, is hypothesized.
  • Future research should carefully consider timing, carbohydrate intake, bacterial overgrowth, and probiotic dosage.

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