Probiotics administration following sleeve gastrectomy surgery: A randomized double-blind trial

S. Sherf-Dagan, S. Zelber-Sagi, G. Zilberman-Schapira, M. Webb, A. Buch, A. Keidar, A. Raziel, N. Sakran, D. Goitein, N. Goldenberg, J. A. Mahdi, M. Pevsner-Fischer, N. Zmora, M. Dori-Bachash, E. Segal, E. Elinav, O. Shibolet

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Background:Probiotics are commonly used after bariatric surgery; however, uncertainty remains regarding their efficacy. Our aim was to compare the effect of probiotics vs placebo on hepatic, inflammatory and clinical outcomes following laparoscopic sleeve gastrectomy (LSG).Methods:This randomized, double-blind, placebo-controlled, trial of 6-month treatment with probiotics (Bio-25; Supherb) vs placebo and 6 months of additional follow-up was conducted among 100 morbidly obese nonalcoholic fatty liver disease (NAFLD) patients who underwent LSG surgery. The primary outcome was a reduction in liver fat content, measured by abdominal ultrasound, and secondary outcomes were improvement of fibrosis, measured by shear-wave elastography, metabolic and inflammatory parameters, anthropometrics and quality of life (QOL). Fecal samples were collected and analyzed for microbial composition.Results:One hundred patients (60% women, mean age of 41.9±9.8 years and body mass index of 42.3±4.7 kg m '2) were randomized, 80% attended the 6-month visit and 77% completed the 12-month follow-up. Fat content and NAFLD remission rate were similarly reduced in the probiotics and placebo groups at 6 months postsurgery ('0.9±0.5 vs '0.7±0.4 score; P=0.059 and 52.5 vs 40%; P=0.262, respectively) and at 12 months postsurgery. Fibrosis, liver-enzymes, C-reactive protein (CRP), leptin and cytokeratin-18 levels were significantly reduced and QOL significantly improved within groups (P1/20.014 for all), but not between groups (P3/40.173 for all) at 6 and 12 months postsurgery. Within-sample microbiota diversity (alpha-diversity) increased at 6-month postsurgery compared with baseline in both study arms (P1/20.008) and decreased again at 12 months postsurgery compared with 6 months postsurgery (P1/20.004) but did not reach baseline values.Conclusions:Probiotics administration does not improve hepatic, inflammatory and clinical outcomes 6- and 12 months post-LSG.

Original languageEnglish
Pages (from-to)147-155
Number of pages9
JournalInternational Journal of Obesity
Issue number2
StatePublished - 1 Feb 2018
Externally publishedYes


This study was supported (in part) by grant no. 3-10470 from the Chief Scientist Office of the Ministry of Health, Israel. The funding source did not have a role in the design, conduct and analysis of the study or the decision to submit the manuscript for publication.

FundersFunder number
Ministry of Health, State of Israel


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