Annals of Clinical Nutrition and Metabolism

Review

Postoperative gut dysbiosis and its clinical implications, with an emphasis on probiotic strategies in gastric cancer patients undergoing gastrectomy: a narrative review: Cheong Ah Oh; Ann Clin Nutr Metab 2025;17(2):114-124. Published online August 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0023

Abstract PDF: Purpose
This review explores alterations in gut microbiota following gastrointestinal surgery, with a focus on gastrectomy for gastric cancer, and evaluates the therapeutic potential of probiotics in restoring microbial balance and reducing postoperative complications, including infections, inflammation, immune dysfunction, and cancer recurrence.
Current concept
Gastrointestinal surgery disrupts gut microbial homeostasis via surgical stress, oxygen exposure, altered bile flow, and perioperative antibiotic use. Gastrectomy, in particular, induces marked changes in the microbiota, including increased oral-origin and aerotolerant bacteria, decreased short-chain fatty acid–producing species, and elevated bile acid-transforming organisms. These alterations contribute to complications such as small intestinal bacterial overgrowth, surgical site infections, postoperative ileus, nutrient malabsorption, and potentially a higher risk of colorectal cancer. Probiotics—especially strains of Lactobacillus, Bifidobacterium, and Clostridium—have demonstrated beneficial effects by modulating the gut ecosystem, enhancing epithelial barrier integrity, and regulating immune and metabolic pathways. Randomized clinical trials support using probiotics in improving gastrointestinal recovery, reducing systemic inflammation, restoring microbial diversity, and shortening hospital stays after gastrectomy. Multi-strain probiotic formulations, particularly when administered perioperatively, show the greatest promise. However, safety concerns remain, especially for immunocompromised or critically ill patients, underscoring the need for rigorous clinical oversight and adherence to regulatory standards such as the European Food Safety Authority’s Qualified Presumption of Safety guidelines.
Conclusion
Postoperative dysbiosis is a modifiable factor in adverse surgical outcomes. Probiotic supplementation offers promising therapeutic potential in patients undergoing gastrectomy, though optimal strains, dosing, and timing remain to be determined. Tailored, evidence-based strategies may ultimately enhance both recovery and long-term outcomes after gastric cancer surgery.

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Review Article

Effect of Probiotics/Synbiotics on Postoperative Outcomes in Patients Undergoing Abdominal Surgery: In Ja Park; Ann Clin Nutr Metab 2022;14(1):10-19. Published online June 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.1.10

Environmental factors, drugs, diet, and surgery alter the composition of the gut microbiota leading to the production of different metabolites or toxins that can cause disease or delay postoperative recovery. Surgical damage leads to gut barrier disruption, increased intestinal permeability, gut microbial imbalance, and immunologic compromise of the host with subsequent bacterial translocation from the gastrointestinal tract to systemic circulation. Therefore, perioperative stabilization of the intestinal microbiota is a potential method of reducing postoperative complication rates. Probiotics have been proposed as a viable option for prophylaxis of postoperative infections through increased intestinal motility to prevent bacterial overgrowth, improve gut barrier function, and modulate immune response. This review investigates microbial changes after surgery and the influence of probiotics on postoperative microbial composition. Infectious postoperative complications and immunologic changes related to probiotics/synbiotics were also reviewed in patients who underwent abdominal surgery.

Citations

Citations to this article as recorded by

Postoperative gut dysbiosis and its clinical implications, with an emphasis on probiotic strategies in gastric cancer patients undergoing gastrectomy: a narrative review
Cheong Ah Oh
Ann Clin Nutr Metab.2025; 17(2): 114. CrossRef
Probiotics in the Management of Surgery- Induced Diarrhea: Efficacy and Clinical Applications
P. Dhivyaprasath, Gayathri R, Poovitha M, Rabiyath Riswana M, Sabithra P, Susitha R
International Journal of Innovative Science and Research Technology.2024; : 1482. CrossRef

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