Abstract
Surgical and medical emergencies, such as myocardial infarction, stroke, severe pancreatitis, trauma and burns, but also advanced medical and surgical treatments, from extensive surgical operations to stem cell transplantations, are associated with an unacceptably high morbidity and mortality. The most common cause is sepsis which, despite all advances in pharmaceutical medicine, is steadily increasing. Sepsis is mainly seen in elderly patients and patients with a malfunctioning innate immune system and subsequent elevated inflammatory response. In the past, multiple attempts have been made to control sepsis and subsequent organ failure, but with no or limited success, using branched chain amino acids, glutamine, growth hormone, insulin, insulin-like growth factor 1, various vitamins, as well as combinations of nutrients, including so-called immunoenhancing nutrition formulae. Aggressive perioperative enteral nutrition, tight control of blood sugar, supplementation of antioxidants, plant fibres and lactic acid bacteria (LAB) so far seem to offer the greatest hope to reduce the rate of sepsis, inflammation and subsequent single and multiple organ failure. Studies combining plant fibres and bioactive LAB have shown a unique ability to eliminate sepsis in severe acute pancreatitis (SAP), in connection with advanced surgical operations but also in infection-sensitive chronic diseases such as chronic liver disease. Experimental studies show prevention of sepsis-induced neutrophil infiltration of the lung and tissue destruction, the most common target for single organ failure. Clinical studies in SAP demonstrate significant reduction in systemic inflammatory responses in multiple organ failure. The effects observed are unique to specific LAB and specific fibres and cannot be reproduced with “yoghurt” bacteria. The choice of LAB is critical as most LAB do not survive the harsh climate in the stomach and upper intestine, and cannot adhere to the intestinal mucosa and reproduce.
| Abbreviations | ||
| ARDS | = | acute respiratory distress syndrome |
| ICAM-1 | = | intercellular adhesion molecule-1 |
| IL-6 | = | interleukin-6 |
| ITU | = | intensive therapy unit |
| LAB | = | lactic acid bacteria |
| MOF | = | multiple organ failure |
| PAF | = | platelet activating factor |
| PAI-1 | = | plasminogen activator inhibitor-1 |
| PMN | = | polymorphonuclear |
| PPMs | = | potentially pathogenic microorganisms |
| SAP | = | severe acute pancreatitis |
| SIRS | = | systemic inflammatory reaction syndrome |
| TNF-α | = | tumour necrosis factor-α |
| Abbreviations | ||
| ARDS | = | acute respiratory distress syndrome |
| ICAM-1 | = | intercellular adhesion molecule-1 |
| IL-6 | = | interleukin-6 |
| ITU | = | intensive therapy unit |
| LAB | = | lactic acid bacteria |
| MOF | = | multiple organ failure |
| PAF | = | platelet activating factor |
| PAI-1 | = | plasminogen activator inhibitor-1 |
| PMN | = | polymorphonuclear |
| PPMs | = | potentially pathogenic microorganisms |
| SAP | = | severe acute pancreatitis |
| SIRS | = | systemic inflammatory reaction syndrome |
| TNF-α | = | tumour necrosis factor-α |