Influences of probiotics plus enteral nutrition on intestinal flora and inflammatory response in patients with severe acute pancreatitis.

INTRODUCTION: Severe acute pancreatitis (SAP) is frequently accompanied by intestinal barrier disruption, systemic inflammation, and gut microbiota dysbiosis. Although enteral nutrition (EN) is standard in SAP management, EN alone may not fully restore the intestinal microenvironment. This study evaluated whether probiotics combined with EN improve intestinal mucosal integrity, inflammatory responses, immune status, nutritional indices, and intestinal flora in SAP patients. METHODS: In this prospective, randomized, double-blind, placebo-controlled trial, 130 SAP patients were assigned to receive EN plus probiotics or EN plus placebo for 14 days. All patients received standardized supportive care and post-pyloric EN. Outcomes included time to abdominal pain relief, hospital stay, mortality, persistent organ failure, ICU utilization, intestinal mucosal barrier markers (endotoxin, diamine oxidase), inflammatory cytokines (CRP, TNF-α, IL-6), immune indicators (IgG, IgM, IgA), nutritional markers (prealbumin, albumin, transferrin), and quantitative fecal microbiota counts at baseline, day 7, and day 14. Statistical significance was defined as p < 0.05. RESULTS: Compared with controls, the probiotic group showed shorter abdominal pain relief time (4.21 ± 0.53 vs. 5.85 ± 0.62 days) and reduced hospital stay (20.02 ± 2.14 vs. 26.34 ± 3.25 days) (both p < 0.05). No differences were found in 28-day mortality, in-hospital mortality, persistent organ failure, ICU admission, or ICU stay. Probiotics produced greater reductions in endotoxin, diamine oxidase, CRP, TNF-α, and IL-6, and greater increases in IgG, IgM, IgA, prealbumin, albumin, and transferrin. The study group also exhibited higher lactobacilli and bifidobacteria counts and lower enterobacteria and enterococci counts at days 7 and 14 (all p < 0.05). DISCUSSION: Probiotics combined with EN improved intestinal barrier function, inflammation, immunity, nutrition, and microbiota composition, although without reducing mortality or major complications.