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Postoperative symbiotic in patients with head and neck cancer: a double-blind randomised trial

  • Priscilla C. Lages (a1), Simone V. Generoso (a1) and Maria Isabel T. D. Correia (a2)
Abstract

Studies on the ‘gut origin of sepsis’ have suggested that stressful insults, such as surgery, can affect intestinal permeability, leading to bacterial translocation. Symbiotics have been reported to be able to improve gut permeability and modulate the immunologic system, thereby decreasing postoperative complications. Therefore we aimed to evaluate the postoperative use of symbiotics in head and neck cancer surgical patients for intestinal function and permeability, as well as the postoperative outcomes. Patients were double-blind randomised into the symbiotic (n 18) or the control group (n 18). Samples were administered twice a day by nasoenteric tube, starting on the 1st postoperative day until the 5th to 7th day, and comprised 109 colony-forming units/ml each of Lactobacillus paracasei, L. rhamnosus, L. acidophilus, and Bifidobacterium lactis plus 6 g of fructo-oligosaccharides, or a placebo (6 g of maltodextrin). Intestinal function (day of first evacuation, total stool episodes, stool consistency, gastrointestinal tract symptoms and gut permeability by diamine oxidase (DAO) enzyme) and postoperative complications (infectious and non-infectious) were assessed. Results of comparison of the pre- and postoperative periods showed that the groups were similar for all outcome variables. In all, twelve patients had complications in the symbiotic group v. nine in the control group (P>0·05), and the preoperative-postoperative DAO activity ranged from 28·5 (sd 15·4) to 32·7 (sd 11·0) ng/ml in the symbiotic group and 35·2 (sd 17·7) to 34·1 (sd 12·0) ng/ml in the control group (P>0·05). In conclusion, postoperative symbiotics did not impact on intestinal function and postoperative outcomes of head and neck surgical patients.

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Corresponding author
* Corresponding author: P. C. Lages, fax +55 31 3409 8028, email priscillaceci@gmail.com
References
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1. Correia, MI, Liboredo, JC & Consoli, ML (2012) The role of probiotics in gastrointestinal surgery. Nutrition 28, 230234.
2. van Bokhorst-De van der Schuer, MA, von Blomberg-van der Flier, BM, Riezebos, RK, et al. (1998) Differences in immune status between well-nourished and malnourished head and neck cancer patients. Clin Nutr 17, 107111.
3. Gibson, GR & Roberfroid, MB (1995) Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr 125, 14011412.
4. Bazzocchi, G, Giovannini, T, Giussani, C, Brigidi, P & Turroni, S (2014) Effect of a new synbiotic supplement on symptoms, stool consistency, intestinal transit time and gut microbiota in patients with severe functional constipation: a pilot randomized double-blind, controlled trial. Tech Coloproctol 18, 945953.
5. Rayes, N, Hansen, S, Seehofer, D, et al. (2002) Early enteral supply of fiber and lactobacilli versus conventional nutrition: a controlled trial in patients with major abdominal surgery. Nutrition 18, 609615.
6. Rayes, N, Seehofer, D, Hansen, S, et al. (2002) Early enteral supply of lactobacillus and fiber versus selective bowel decontamination: a controlled trial in liver transplant recipients. Transplantation 74, 123127.
7. Rayes, N, Seehofer, D, Theruvath, T, et al. (2005) Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation--a randomized, double-blind trial. Am J Transplant 5, 125130.
8. Rammohan, A, Sathyanesan, J, Rajendran, K, et al. (2015) Synbiotics in surgery for chronic pancreatitis: are they truly effective? A single blind prospective randomized control trial. Ann Surg 262, 3137.
9. Rayes, N, Seehofer, D, Theruvath, T, et al. (2007) Effect of enteral nutrition and synbiotics on bacterial infection rates after pylorus-preserving pancreatoduodenectomy: a randomized, double-blind trial. Ann Surg 246, 3641.
10. Tanaka, K, Yano, M, Motoori, M, et al. (2012) Impact of perioperative administration of synbiotics in patients with esophageal cancer undergoing esophagectomy: a prospective randomized controlled trial. Surgery 152, 832842.
11. Reddy, BS, Macfie, J, Gatt, M, Larsen, CN, Jensen, SS & Leser, TD (2007) Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg 94, 546554.
12. Krebs, B (2016) Prebiotic and Synbiotic treatment before colorectal surgery – randomised double blind trial. Coll Antropol 40, 3540.
13. Anderson, AD, McNaught, CE, Jain, PK & MacFie, J (2004) Randomised clinical trial of synbiotic therapy in elective surgical patients. Gut 53, 241245.
14. Bieganski, T, Kusche, J, Lorenz, W, Hesterberg, R, Stahlknecht, CD & Feussner, KD (1983) Distribution and properties of human intestinal diamine oxidase and its relevance for the histamine catabolism. Biochim Biophys Acta 756, 196203.
15. Takagi, K, Nakao, M, Ogura, Y, Nabeshima, T & Kunii, A (1994) Sensitive colorimetric assay of serum diamine oxidase. Clin Chim Acta 226, 6775.
16. Edge, SB & Compton, CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17, 14711474.
17. Detsky, AS, McLaughlin, JR, Baker, JP, et al. (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11, 813.
18. Budziareck, MB, Pureza Duarte, RR & Barbosa-Silva, MC (2008) Reference values and determinants for handgrip strength in healthy subjects. Clin Nutr 27, 357362.
19. Lewis, SJ & Heaton, KW (1997) Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 32, 920924.
20. Dindo, D, Demartines, N & Clavien, PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240, 205213.
21. Kamiya, S, Nagino, M, Kanazawa, H, et al. (2004) The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg 239, 510517.
22. Armitage, P & Berry, G (1987) The planning of statistical investigations.In Statistical Methods in Medical Research, 2nd ed., pp. 179185 [P Armitage and G Berry, editors]. Oxford, UK: Blackwell Scientific.
23. Suchodolski, JS & Jergens, AE (2016) Recent advances and understanding of using probiotic-based interventions to restore homeostasis of the microbiome for the prevention/therapy of bacterial diseases. Microbiol Spectr 4, 114.
24. Galbiatti, AL, Padovani-Junior, JA, Maniglia, JV, Rodrigues, CD, Pavarino, EC & Goloni-Bertollo, EM (2013) Head and neck cancer: causes, prevention and treatment. Braz J Otorhinolaryngol 79, 239247.
25. van Bokhorst-de van der Schueren, MA, van Leeuwen, PA, Sauerwein, HP, Kuik, DJ, Snow, GB & Quak, JJ (1997) Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck 19, 419425.
26. Jager-Wittenaar, H, Dijkstra, PU, Vissink, A, van der Laan, BF, van Oort, RP & Roodenburg, JL (2011) Malnutrition and quality of life in patients treated for oral or oropharyngeal cancer. Head Neck 33, 490496.
27. Gourin, CG, Couch, ME & Johnson, JT (2014) Effect of weight loss on short-term outcomes and costs of care after head and neck cancer surgery. Ann Otol Rhinol Laryngol 123, 101110.
28. Takimoto, Y, Yoshiuchi, K, Shimodaira, S & Akabayashi, A (2014) Diamine oxidase activity levels in anorexia nervosa. Int J Eat Disord 47, 203205.
29. Sugawara, G, Nagino, M, Nishio, H, et al. (2006) Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg 244, 706714.
30. Kanazawa, H, Nagino, M, Kamiya, S, et al. (2005) Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg 390, 104113.
31. Levine, EA & Alverdy, JC (1990) Carotid-esophageal fistula following a penetrating neck injury: case report. J Trauma 30, 15881590.
32. Shogan, BD, Smith, DP, Christley, S, Gilbert, JA, Zaborina, O & Alverdy, JC (2014) Intestinal anastomotic injury alters spatially defined microbiome composition and function. Microbiome 2, 35.
33. Yang, Z, Wu, Q, Liu, Y & Fan, D (2017) Effect of perioperative probiotics and synbiotics on postoperative infections after gastrointestinal surgery: a systematic review with meta-analysis. JPEN J Parenter Enteral Nutr 41, 10511062.
34. Wang, R, Chen, S, Jin, J, et al. (2015) Survival of Lactobacillus casei strain Shirota in the intestines of healthy Chinese adults. Microbiol Immunol 59, 268276.
35. Stadlbauer, V, Leber, B, Lemesch, S, et al. (2015) Lactobacillus casei shirota supplementation does not restore gut microbiota composition and gut barrier in metabolic syndrome: a randomized pilot study. PLOS ONE 10, e0141399.
36. Kristensen, NB, Bryrup, T, Allin, KH, Nielsen, T, Hansen, TH & Pedersen, O (2016) Alterations in fecal microbiota composition by probiotic supplementation in healthy adults: a systematic review of randomized controlled trials. Genome Med 8, 52.
37. Gorshein, E, Wei, C, Ambrosy, S, et al. (2017) Lactobacillus rhamnosus GG probiotic enteric regimen does not appreciably alter the gut microbiome or provide protection against GVHD after allogeneic hematopoietic stem cell transplantation. Clin Transplant 31, 115.
38. McNaught, CE, Woodcock, NP, MacFie, J & Mitchell, CJ (2002) A prospective randomised study of the probiotic Lactobacillus plantarum 299V on indices of gut barrier function in elective surgical patients. Gut 51, 827831.
39. Maintz, L & Novak, N (2007) Histamine and histamine intolerance. Am J Clin Nutr 85, 11851196.
40. Xie, Q & Gan, HT (2010) Controversies about the use of serological markers in diagnosis of inflammatory bowel disease. World J Gastroenterol 16, 279280.
41. Jeppsson, B, Mangell, P & Thorlacius, H (2011) Use of probiotics as prophylaxis for postoperative infections. Nutrients 3, 604612.
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
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