Kapil Kotecha,
Vojislav N. Peri{i}
Pre-, Probiotics, synbiotics in perioperative nutrition
Address correspondence to:
Professor Dr Vojislav N. Peri{i}, PhD, FRCP
Outwood Ward, East Surrey General Hospital
Canada Avenue, Redhill,
West Sussex RH1 5RH, United Kingdom
Gastroenterolo{ka sekcija SLD-
01755, 2003.
Nutrition and alimentary tract
Ishrana i alimentarni trakt
East Surrey General Hospital, Redhill,
United Kingdom
ARCH GASTROENTEROHEPATOL 2002; 21 ( No 3 - 4 ): 73 - 78
Minisymposium on functional food
Perioperative nutrition:
The role of prebiotics,
probiotics and synbiotics
Perioperativna ishrana: Uloga prebiotika,
probiotika i simbiotika
(accepted December 3rd, 2003)
Since the introduction of inhalation anaesthesia,
patients have been required to fast about 12 hours
before operations. Thereafter, after major surgical
operations oral and enteral feeding is oftenly avoided
for the first days. This is because it was believed that
during the first few days after trauma and operations
GI is paralysed. This seems to be true only for the
stomach and partly for the colon (1). Because the small
intestinal motility and to some extent the colon is
remained active, an uninterrupted postoperative enter-
al supply of nutrients should always be technically pos-
sible, at least if enteral feeding tubes are used to bypass
Abstract
The leading sequel to surgery is overreaction of the acute phase response which causes the two major
perioperative complications: sepsis and thrombosis.The gastrointestinal tract (GI), especially the colon,
is a major player in the acute phase response. Maintenance of GI environment is a key factor in deter-
mining outcome in critically ill and postoperative patients. It is important to maintain GI secretions, oral
intake of anti-infections and anti-inflammatory compounds, and the colonic flora. Prebiotics are fruit,
vegetable and plant polysaccharides with strong bioactivity. When ingested they reduce the rate of infec-
tions in critically ill surgical patients. Probiotics reduce or eliminate potentially pathogenic micro-organ-
isms from GI, reduce or eliminate various toxins, modulate innate and adaptive immune defence mech-
anisms, and release numerous nutrients, antioxidants, growth and coagulation factors necessary for
recovery. Synbiotics are combination of prebiotics and probiotics. There is increasing number of stud-
ies demonstrated great benefit of symbiotic treatment of critically ill surgical patients which is becom-
ing new treatment paradigms.
Key Words:
prebiotics,
probiotics,
synbiotics,
postoperative care,
surgical operations,
infections, sepsis.
Sa`etak
Reakcija akutne faze je glavna sekvela hirur{kih zahvata.Ona prouzrokuje klju~ne perioperativne komp-
likacije: sepsu i trombozu. Gastrointestinalni trakt (GI), posebno debelo crevo, ima glavnu ulogu u reakci-
ji akutne faze. Odr`avanje nepromenjenog mikro-ekosistema GI je od velikog zna~aja za ishod kriti~no
bolesnih i operisanih pacijenata. Za tu grupu bolesnika odr`avanje stalnosti GI sekrecija, oralni unos anti-
infektivnih i antintiinflamatornih jedinjenja, i neizmenjenost flore debelog creva je od velikog zna~aja.
Prebiotici su polisaharidi vo}a, povr}a i biljaka koji su veoma biolo{ki aktivni. U grupi kriti~no bolesnih i
operisanih pacijenata kada su oralno uneti, smanjuju rizik infekcija. Probiotici smanjuju ili elimini{u poten-
cijalno patogene mikroorganizme u GI, redukuju ili odstranjuju razli~ite toksine, moduliraju osnovne i
ste~ene reakcije imunolo{kog sistema, i stvaraju raznovrsne nutrijente, antioksidante, faktore rasta i koag-
ulacije neophodne za oporavak bolesnika. Sinbiotici su kombinacija prebiotika i probiotika. Sve je ve}i broj
studija koje pokazuju veliku korist njihove primene u le~enju te{kih hirur{kih bolesnika te se ~ini da oni
postaju nova terapijska paradigma.
Klju~ne re~i:
prebiotici,
probiotici,
sinbiotici,
postoperativno le~enje,
hirur{ki zahvati,
infekcije, sepsa.
