Effect of a novel enteral nutrition mixture with probiotics versus standard enteral nutrition on gastrointestinal complications in critically ill surgical patients

The study, “Effect of a Novel Enteral Nutrition Mixture with Probiotics versus Standard Enteral Nutrition on Gastrointestinal Complications in Critically Ill Surgical Patients: A Single-Center Randomized Controlled Trial,” was carried out by Sergey V. Kapralov, Inna V. Simakova, Reyzudin I. Idrisov, Victoria N. Strizhevskaya, Stanislav I. Krivosheev, Margarita A. Simakova, Alla B. Bucharskaya, Maksim S. Maradudin, Anatoly V. Voronin, Elena P. Rusanova, Zhibing Xu, Xueqing Hang, and Anton R. Kiselev in the Journal of Human Nutrition and Probiotics.

A randomised controlled trial conducted in critically ill patients recovering from abdominal surgery found that a novel probiotic-enriched tube feeding formula reduced serious gut complications dramatically compared to standard enteral nutrition — with no cases of diarrhea recorded in the probiotic group, against a 60% rate in the control group — though the authors caution that the two formulas also differed in their nutritional composition, making it impossible to attribute the benefit to probiotics alone.

Gut complications

When a patient undergoes major abdominal surgery and ends up in intensive care, feeding them adequately is not a secondary concern — it is a critical part of their recovery. Enteral nutrition, the delivery of liquid feed directly into the stomach or intestine through a tube, is the preferred method for maintaining nutritional status in patients who cannot eat normally, and it is well established that getting nutrition right in the early postoperative period improves outcomes, shortens recovery time, and reduces the risk of complications.

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What is far less well understood is whether adding probiotics — live beneficial bacteria — to the enteral feed can further protect the gut from the complications that commonly follow major abdominal surgery. These complications, which include diarrhea, abdominal pain, intestinal paresis (a condition where the gut temporarily stops moving contents forward), and in the most serious cases peritonitis, are not minor inconveniences; in a critically ill patient, they can extend time on the feeding tube, delay recovery, and worsen overall outcomes.

Despite the theoretical rationale for probiotic use in this setting and a growing body of evidence in other patient populations, controlled trial data specifically in severe postoperative patients with abdominal pathology had been absent — a gap this study directly addresses.

Striking differences in outcomes

The trial enrolled 50 patients at a single centre, randomly assigning 30 to receive a novel enteral nutrition product called GASTROAXILIUM+ — which combines a probiotic component with a specific macronutrient profile — and 20 to receive a standard enteral nutrition formula. Researchers then tracked a pre-specified set of gastrointestinal outcomes in both groups over the course of their postoperative recovery.

The differences were striking. In the control group, diarrhea — the primary clinical endpoint — occurred in 12 of 20 patients, a rate of 60%. In the GASTROAXILIUM+ group, not a single case of diarrhea was recorded. The gap was equally pronounced for loose stool, a secondary endpoint: 80% of control patients experienced it, compared to just 6.7% in the intervention group.

Beyond these complication rates, the probiotic formula group also recovered gut function faster in two clinically meaningful ways — intestinal paresis resolved 0.6 days earlier on average (4.1 days versus 4.7 days, p=0.048), and the feeding tube was removed 0.6 days sooner (4.2 days versus 4.8 days, p=0.036).

While these time differences may appear modest in absolute terms, in an intensive care setting where every additional day on a feeding tube carries risks of its own and consumes significant nursing and medical resources, even incremental improvements in recovery speed carry practical value.

What the results mean 

The authors are careful to draw the boundary around what these results actually demonstrate. The GASTROAXILIUM+ formula differed from the standard formula not only in its probiotic content but also in its overall macronutrient composition, meaning the trial was not a clean test of probiotics in isolation.

The improved outcomes could reflect the probiotic component, the different nutritional balance, or a combination of both — and the study design does not allow these contributions to be separated. This is an important caveat that the authors themselves highlight, and it defines the primary question that future research must answer.

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The trial is also limited by its single-centre design and relatively small sample size, both of which constrain how confidently the results can be generalised to other patient populations and clinical settings.

Promising results

What the study does establish clearly is that the GASTROAXILIUM+ formula, as a complete product, was associated with substantially better gastrointestinal outcomes than standard enteral nutrition in this population — a finding that is clinically meaningful in its own right and that provides a strong rationale for larger, multicentre trials capable of unpicking the relative contributions of the probiotic and nutritional components.

The research was led by corresponding author Dr. Anton R. Kiselev, alongside twelve co-authors representing institutions in Russia and China.