Integrated metabolomic insights into the mechanism of Bacillus coagulans in enhancing intestinal recovery following gynecological laparoscopic surgery: a randomized clinical trial

Juan Xu¹Lingjun Dong^1,2Chunqi Fen^1,2Zhaobo Guan^1,3Jingmin Zhang¹Niuniu Bai¹Zhanqin Niu¹Weihong Chen^1,2*Weiqi Gao^1,2,4*

• ¹Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
• ²School of Pharmacy, Shanxi Medical University, Taiyuan, China
• ³Department of Pharmacy, Changzhi People’s Hospital, The Afliated Hospital of Shanxi Medical University, Changzhi, China
• ⁴Shanxi Academy of Advanced Research and Innovation (SAARI), Taiyuan, China

Objective: To evaluate the efficacy and mechanistic underpinnings of live Bacillus coagulans tablets in accelerating recovery of intestinal function after gynecologic laparoscopic surgery. Methods: A randomized, double-blind, placebo-controlled trial included 115 patients undergoing gynecological laparoscopy, assigned to placebo control (PC, n=39), conventional dose (CD, n=38), and high dose (HD, n=38) groups. Clinical recovery was assessed by timing of first postoperative bowel movement and gastrointestinal adverse reactions. Plasma levels of motilin (MTL) and serotonin (5-HT) were measured using ELISA. Plasma metabolite profiles were analyzed via metabolomics to elucidate treatment-related metabolic pathways. Results: Treatment groups (CD and HD) exhibited significantly reduced time to first postoperative defecation and fewer gastrointestinal adverse reactions compared to PC (P<0.05), without significant differences between CD and HD groups. Plasma MTL and 5-HT levels significantly increased postoperatively in the treatment groups compared with PC (P<0.05), without dose-dependent differences. Metabolomics identified 50 and 73 differential metabolites in CD and HD groups post-treatment, respectively, enriched mainly in pathways involving tryptophan, tyrosine, histidine, kynurenine, primary bile acids, and short-chain fatty acids. Conclusion: Live Bacillus coagulans tablets effectively promoted postoperative intestinal recovery in patients undergoing gynecological laparoscopy. The mechanisms likely involve enhanced secretion of MTL and 5-HT, coupled with regulation of key metabolic pathways including tryptophan, tyrosine, kynurenine, histidine metabolism, primary bile acid synthesis, and SCFA metabolism. This study provides insights into probiotics' potential to improve postoperative gastrointestinal outcomes.