Plain language summary
Acute pancreatitis (AP) is commonly associated with gastrointestinal (GI) dysfunction in the early phase which in turn increases the risk of infectious complications and as such poorer prognosis. Lactulose is a prebiotic that can modulate the gut microbiota and intestinal metabolites. The aim of this open-label, randomised controlled study, involving 83 patients with moderate-severe AP and associated GI dysfunction, was to evaluate the efficacy of lactulose on intestinal function, infectious complications and prognosis compared to rhubarb, which has shown benefits for the aforementioned outcomes of AP. GI function improved significantly within 7 days in both groups, with no difference between groups. Whilst one marker (D-lac) of intestinal permeability was improved in both groups after 7 days, another marker (DAO) showed no improvement in either group. There was no significant difference between groups in this respect. There was no difference in clinical outcomes between groups, but certain inflammatory markers (TNF-a, IL-6) declined more in the lactulose than in the rhubarb group. More beneficial changes in the microbiota and its metabolites were seen in the lactulose, compared to the rhubarb group. The authors concluded that lactulose is a potent alternative to rhubarb for patients with AP and associated GI dysfunction.
Abstract
BACKGROUND Intestinal dysfunction is one of the common complications in the early stage of acute pancreatitis (AP), which often associates with bad outcome. Lactulose, as a prebiotic, has been widely used to improve gut health, yet its effect on AP is unclear. METHODS This was a prospective, randomized trial of moderate severe AP patients complicated with intestinal dysfunction. A total of 73 participants were randomly assigned to receive either lactulose or Chinese herb rhubarb for 1 week. The primary efficacy endpoint was the recovery of intestinal function. The serum levels of inflammatory cytokines and gut barrier indexes were examined. The fecal samples from patients before and after treatment were collected. 16 S rRNA gene sequencing analysis was performed to explore the composition of gut microbiota and the amount of short-chain fatty acids (SCFAs) were detected by gas chromatography-mass spectrometry (GC-MS). RESULTS The intestinal dysfunction was prominently improved after 7 days of treatment with either lactulose or rhubarb. The serum levels of cytokines and gut permeability index were decreased after treatment, with stronger down-regulated degree in lactulose group than rhubarb. The potential beneficial genus Bifidobacterium was enriched in lactulose group, while pathogenic bacteria including Escherichia-Shigella and Neisseria were abundant in rhubarb group. Of note, the level of SCFAs was remarkably increased after treatment, with higher amount in lactulose group than rhubarb group. CONCLUSIONS Lactulose could not only restore intestinal function but also regulate gut microbiota and promote the production of SCFAs.
Methodological quality
Jadad score
:
3
Allocation concealment
:
Not applicable
