Sir A new therapeutic option for such a morbid condition is warmly welcomed, however our enthusiasm for the approach used in this study is subdued by a number of concerns. 1. The analysis appears to be based on a tolerance rather than intention to treat. Some 10 per cent of patients were excluded. This is of concern as gallstones are responsible for up to two-thirds of cases of pancreatitis in the United Kingdom, and one third globally. 2. Some 25 per cent of patients with pancreatitis develop severe disease. In the present study, the prevalence of severe disease (> 65 per cent) and pancreatic necrosis (47 per cent) was unexpectedly high, skewing the data. 3. The use of jejeunal feeding in all patients with pancreatitis is unsupported; it perhaps affords some benefit only in severe cases. 4. The contingency data analysis is incorrect, with the use of the Chi squared instead of Fischers' Exact test. Such analysis demonstrated no significance (P > 0·05). In our opinion, the current study cannot be employed to advocate the use of probiotics in the routine management of acute pancreatitis. A larger, adequately powered study that includes gallstone aetiology, is necessary.
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Rahman et al. (2003) studied this question.