P4837 - Impact of Probiotic/Synbiotic Supplementation on Post-Bariatric Surgery Anthropometric and Cardiometabolic Outcomes: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Mohamed Saad Rakab, ¹, Rahma Mogahed Rateb, ², Alaa Maamoun, ¹, Nada Radwan, ³, Abdalhakim Shubietah, MD⁴, AlMothana Manasrah, ⁵, Giorgia Scichilone, ⁶, Lisa Tussing-Humphreys, ⁷, Abeer M. Mahmoud, ⁷, Nida Ansari, DO⁸, Abdallah Hussein, MD⁹, Islam Rajab, MD¹⁰, Walid Baddoura, MD¹⁰
1Faculty of Medicine, Mansoura University, Mansoura, Egypt, Mansoura, Ad Daqahliyah, Egypt; 2Faculty of Medicine, Assiut University, Assiut, Egypt, Asyut, Asyut, Egypt; 31Faculty of Medicine, Mansoura University, Mansoura, Egypt, Mansoura, Ad Daqahliyah, Egypt; 4Advocate Illinois Masonic Medical Center, Chicago, IL; 5United Health Services, Wilson Medical Center, Johnson City, NY, USA, Johnson City, NY; 6Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois Chicago, Chicago, IL, USA, Chicago, IL; 7Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA, Chicago, IL; 8St. Joseph's University Medical Center, Flanders, NJ; 9Virtua Our Lady of Lourdes Hospital, Camden, NJ; 10St. Joseph's University Medical Center, Paterson, NJ

Introduction: Bariatric surgery improves weight and metabolic health in individuals with severe obesity; however, challenges like gut dysbiosis and nutrient deficiencies persist postoperatively. Probiotic supplementation may enhance recovery by modulating gut microbiota. This updated meta-analysis aimed to assess the effects of probiotics/synbiotics on metabolic, anthropometric, and nutritional outcomes after bariatric surgery.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching PubMed, Scopus, Web of Science, and Cochrane CENTRAL through December 2024. Eligible studies included adult patients who underwent bariatric surgery and compared probiotics or synbiotics (combinations of probiotics and prebiotics) with placebo. Meta-analyses were performed using mean differences (MD) with 95% confidence intervals for continuous outcomes. Subgroup analyses were conducted based on type of bariatric surgery, timing of intervention, and probiotic formulation. All statistical analyses were performed using R software version 4.3.3.

Results: Thirteen RCTs involving 809 patients were included in the analysis. Probiotic use significantly reduced BMI (MD = 0.99, 95% CI: 0.88 to 1.09), HbA1c (MD = –0.19%, 95% CI: –0.36 to –0.01), Triglycerides (MD = –16.56 mg/dL), AST levels (MD = –3.68 U/L), while increasing ALP (MD = 8.12 U/L) and Vitamin D (MD = 13.68 pg/mL). Ferritin levels were significantly lower (MD = –18.89 µg/L) in the probiotics group. Subgroup analysis showed enhanced benefits in patients undergoing mini-gastric bypass, with perioperative or synbiotic interventions specifically improving triglycerides, total cholesterol, and HbA1c.

Discussion: Probiotics may contribute to modest yet statistically significant improvements in BMI reduction, glycemic control, lipid profile, liver enzyme levels, and vitamin D status following bariatric surgery. These findings highlight the potential of probiotics or synbiotics as valuable adjunct therapies in the postoperative management of bariatric patients. However, larger, high-quality randomized controlled trials are needed to validate these outcomes and establish their long-term efficacy and safety


Figure: Figure 1. Forest plots showing the effects of probiotics/synbiotics vs. placebo on HbA1c, BMI Reduction, vitamin D, and triglyceride levels in post-bariatric patients

Disclosures:
Mohamed Saad Rakab indicated no relevant financial relationships.
Rahma Mogahed Rateb indicated no relevant financial relationships.
Alaa Maamoun indicated no relevant financial relationships.
Nada Radwan indicated no relevant financial relationships.
Abdalhakim Shubietah indicated no relevant financial relationships.
AlMothana Manasrah indicated no relevant financial relationships.
Giorgia Scichilone indicated no relevant financial relationships.
Lisa Tussing-Humphreys indicated no relevant financial relationships.
Abeer M. Mahmoud indicated no relevant financial relationships.
Nida Ansari indicated no relevant financial relationships.
Abdallah Hussein indicated no relevant financial relationships.
Islam Rajab indicated no relevant financial relationships.
Walid Baddoura indicated no relevant financial relationships.

Mohamed Saad Rakab, ¹, Rahma Mogahed Rateb, ², Alaa Maamoun, ¹, Nada Radwan, ³, Abdalhakim Shubietah, MD⁴, AlMothana Manasrah, ⁵, Giorgia Scichilone, ⁶, Lisa Tussing-Humphreys, ⁷, Abeer M. Mahmoud, ⁷, Nida Ansari, DO⁸, Abdallah Hussein, MD⁹, Islam Rajab, MD¹⁰, Walid Baddoura, MD¹⁰. P4837 - Impact of Probiotic/Synbiotic Supplementation on Post-Bariatric Surgery Anthropometric and Cardiometabolic Outcomes: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.