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Effectiveness Of Symbiotic Therapy In Jaundiced Patients

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01683708
Recruitment Status : Unknown
Verified September 2012 by LorenzoCapussotti, Azienda Ospedaliera Ordine Mauriziano di Torino.
Recruitment status was:  Active, not recruiting
First Posted : September 12, 2012
Last Update Posted : September 12, 2012
Information provided by (Responsible Party):
LorenzoCapussotti, Azienda Ospedaliera Ordine Mauriziano di Torino

Brief Summary:
The aim of the present study was therefore to evaluate if the perioperative administration of symbiotics reduces postoperative infectious morbidity in jaundiced patients scheduled for hepato-biliary and pancreatic surgery.

Condition or disease Intervention/treatment
Postoperative Infections Jaundice Dietary Supplement: Symbiotic therapy

Detailed Description:

Despite advances in preoperative patient's selection and anesthetic and surgical techniques, surgery in jaundiced patients is associated with significant morbidity and mortality as a consequence of septic complications. The evidence that nosocomial infections are frequently a consequence of gut-derived organism such as enterobacteriaceae, supports the hypothesis of the "gut derived sepsis". Indeed, several studies have reported that jaundiced patients present an increased intestinal permeability and consequently a higher rate of bacterial migration from gastrointestinal tract across the lamina propria to local mesenteric lymph nodes and from there to extra-intestinal site. This phenomenon increases after surgical decompression of bile duct. The higher prevalence of bacterial translocation in jaundiced patients is related to different mechanisms such as mucosal atrophy secondary to protracted absence of intraluminal bile that open para-cellular route for bacterial translocation and the decreased clearance capacity of Kuppfer secondary to cholestasis.

The mechanisms of action of symbiotics are largely unknown. The probiotic bacteria can improve the mucosal barrier function reducing the bacterial translocation of organism to mesenteric lymph nodes. Indeed symbiotic can affect the intestinal ecosystem by stimulating mucosal immune and non-immune mechanisms through antagonism/competition with potential pathogens.

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Study Type : Observational
Estimated Enrollment : 20 participants
Observational Model: Case Control
Time Perspective: Prospective
Official Title: Effectiveness of Perioperative Symbiotic Therapy to Reduce Infectious Morbidity in Jaundiced Patients: a Randomized Controlled Trial
Study Start Date : November 2008

Group/Cohort Intervention/treatment
Symbiotic group
Jaundiced patients who have symbiotic therapy
Dietary Supplement: Symbiotic therapy
Patients randomized into the Symbiotic group received Prebiotic® in a dose of one sachet twice a day for at least 1 week preoperatively. Postoperatively the medication was reintroduced as tolerated, and continued until discharge from hospital. One 4,5 gr sachet of Prebiotic® contains at least 1010 living Bifidobacterium bifidum, 1010 living Streptococcus Thermophilus, 1010 living Streptococcus Salivarius, 3 109 Lactobacillus Acidophilus, 1010 living Lactobacillus Casei, 1010 living Lactobacillus bulgaricus and galactooligosaccharides (4,5 gr).
Other Name: Prebiotic® (Mediabase s.r.l., Prato, Italy)

No Symbiotic therapy
Jaundiced patients who not have symbiotic therapy

Primary Outcome Measures :
  1. Infectious Morbidity Rate [ Time Frame: Participants will followed for the duration of hospital stay, an expected average of 6 weeks ]

Secondary Outcome Measures :
  1. IMMUNE PROFILE [ Time Frame: The day before and on postoperative day 7 ]
  2. RATE OF TRANSLOCATION [ Time Frame: Intraoperative ]
    a lymph node was routinely excised from the ileocaecal mesentery and was immediately transported in sterile saline to the laboratory for culture

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Jaundiced patients scheduled for hepato-biliary pancreatic surgery

Inclusion Criteria:

  • jaundiced patients scheduled for elective extrahepatic bile duct resections
  • age between 18 and 80 year-old Exclusion Criteria:

Exclusion Criteria

  • cirrhosis
  • American Society of Anesthesiologists (ASA) score 4
  • intestinal malabsorption
  • emergency surgery
  • intolerance to symbiotic
  • diagnosis of primary or secondary immunodeficiency
  • unresectability

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01683708

Sponsors and Collaborators
Azienda Ospedaliera Ordine Mauriziano di Torino
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Principal Investigator: Lorenzo Capussotti, MD Mauriziano Hospital, Department of General and Oncological surgery
Publications of Results:
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Responsible Party: LorenzoCapussotti, Director of Department of General and Oncologica Surgery, Azienda Ospedaliera Ordine Mauriziano di Torino Identifier: NCT01683708    
Other Study ID Numbers: Symbiotic2012
First Posted: September 12, 2012    Key Record Dates
Last Update Posted: September 12, 2012
Last Verified: September 2012
Keywords provided by LorenzoCapussotti, Azienda Ospedaliera Ordine Mauriziano di Torino:
abdominal collection
Additional relevant MeSH terms:
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Pathologic Processes
Skin Manifestations
Signs and Symptoms