Changes in cytokine concentration during enrichment of early enteral nutrition with lactic acid bacterium (Synbiotic 2000) after major abdominal surgery

Background and aims

There is evidence that early enteral nutrition (EEN) enriched with lactic acid bacteria (LAB) and prebiotics may impair the immune response and improve the clinical course of patients undergoing major abdominal surgery. Reduced translocation of potential pathogen bacteria in the gut and changes in the immune system may be responsible for this appearance. The aim of this randomised double-blind trial was to investigate the changes in concentration of cytokines of patients receiving either EEN enriched with LAB or placebo.

Patients and methods

Thirty-three patients undergoing either pylorus-preserving pancreaticoduodenectomy or Whipple's operation were enrolled. EEN enriched with either LAB (Synbiotic 2000™) (n = 17) or placebo (n = 16) was supplied after double-blind randomisation for a period of 5 days beginning the day before the operation. Samples were taken before surgery as well as postoperatively on days 1, 4 and 8. The plasma samples were centrifuged and quickly frozen to -70°C. The concentration of cytokines was measured by the specific ELISA technique (OptEIA Human set, Pharmingen, USA) in standard procedure.

Results

IL-6 increased in both groups until day 1, significantly. In further progress a decrease could be seen. In contrast, IL-12 decreased after the operation and increased until day 8 to nearly the same level as at the onset of the investigation (placebo group 36.27 ± 48.67 pg/ml; verum group 56.58 ± 69.43 pg/ml).

Simultaneously, the amount of interferon gamma (IFNγ) decreased postoperatively in the verum group and increased in the placebo group. But all differences seen were only tendencies, no significance could be shown.

The concentration of IL-10 increased after the operation. However, there was a higher increase from the day before surgery until day 4 in the verum group than in the placebo group.

Summary and conclusion

Enrichment of EEN with LAB seems to have no significant influence on the known postoperative increase of IL-6 or the decrease of IL-12 concentration. In contrast, the LAB supply seems to impair the amount of IL-10 and IFNγ. Further investigations are necessary to elucidate the underlying mechanisms.