A Prospective, Randomized, Placebo-Controlled Trial of Prednisone and Allopurinol in the Prevention of ERCP-Induced Pancreatitis

Budzyńska, Agnieszka; Trněný, Marek; Nowak, Andrzej; Kaczor, R; Nowakowska-Duława, Ewa

doi:10.1055/s-2001-16520

Cited by 95 publications

(85 citation statements)

References 20 publications

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“…The histological abnormalities in the combined treatment group were significantly less compared with the use of allopurinol and HBO alone, indicating a potentiation of effect. Allopurinol also decreased the oxidative stress parameters, as it has been reported previously [13,14,27,28] , although allopurinol was found to have no effect on the incidence and severity of endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis in studies on human subjects by Budzynska et al [29] . When allopurinol was co-administered with HBO at the same doses, the overall antioxidant effect did not increase.…”

Section: Discussionsupporting

confidence: 58%

Combination of allopurinol and hyperbaric oxygen therapy: A new treatment in experimental acute necrotizing pancreatitis?

Cömert¹

2007

WJG

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AIM:To investigate the individual and combined effects of allopurinol and hyperbaric oxygen (HBO) therapy on biochemical and histopathological changes, oxidative stress, and bacterial translocation (BT) in the experimental rat acute pancreatitis (AP). METHODS:Eighty-five Sprague-Dawley rats were included in the study. Fifteen of the eighty-five rats were used as controls (sham, GroupⅠ). AP was induced via intraductal taurocholate infusion in the remaining seventy rats. Rats that survived to induction of acute necrotizing pancreatitis were randomized into four groups. Group Ⅱ received saline, Group Ⅲ allopurinol, Group Ⅳ allopurinol plus HBO and Group Ⅴ HBO alone. Serum amylase levels, oxidative stress parameters, BT and histopathologic scores were determined. RESULTS:Serum amylase levels were lower in Groups Ⅲ, Ⅳ and Ⅴ compared to Group Ⅱ (974 ± 110, 384 ± 40, 851 ± 56, and 1664 ± 234 U/L, respectively, P < 0.05, for all). Combining the two treatment options revealed significantly lower median [25-75 percentiles] histopathological scores when compared to individual administrations (13 [12.5-15] in allopurinol group, 9.5 [7-11.75] in HBO group,[6][7].5] in combined group, P < 0.01). Oxidative stress markers were significantly better in all treatment groups compared to the controls. Bacterial translocation into the pancreas and mesenteric lymph nodes was lower in Groups Ⅲ, Ⅳ and Ⅴ compared to Group Ⅱ (54%, 23%, 50% vs 100% for translocation to pancreas, and 62%, 46%, 58% vs 100% for translocation to mesenteric lymph nodes, respectively, P < 0.05 for all). CONCLUSION:The present study confirms the benefit of HBO and allopurinol treatment when administered separately in experimental rat AP. Combination of these treatment options appears to prevent progression of pancreatic injury parameters more effectively.

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Section: Discussionsupporting

confidence: 58%

Combination of allopurinol and hyperbaric oxygen therapy: A new treatment in experimental acute necrotizing pancreatitis?

Cömert¹

2007

WJG

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“…Moseler and colleagues, in another large-scale trial found no statistical difference in the frequency of PEP in patients given allopurinol (13%) compared with those given a placebo (12%) [112] . Budzynska et al [106] reported similar rates of pancreatitis in 200 patients who received either allopurinol (12%) or placebo (8%). If one was to pool the results of all 3 studies in a crude metaanalysis, total rates of pancreatitis in the allopurinol groups (62 of 579, 10.7%) and the placebo groups (71 of 565, 12.6%) are not statistically different.The allopurinol dosage and the timing of administration differ among all 3 studies: 600 mg at 15 and 3 h before ERCP in the Katsinelos study, 600 mg at 4 h and 300 mg 1 hour before ERCP in the Mosler study, and 200 mg at 15 h and 3 h before ERCP in the Budzynska study.…”

Section: Category 3: Markers Of Systemic Inflammationmentioning

confidence: 76%

“…Two studies (without adjustment for confounding variables or multivariate analysis) suggested that corticosteroids might be protective [104,105] . Subsequently, 5 randomized controlled trials with large numbers of patients demonstrated no benefit, nor any trend toward a benefit, for various corticosteroid formulations, including methylprednisolone, hydrocortisone, and prednisone [106][107][108][109][110] . In a similar approach, it was hoped that xanthine oxidase inhibitors, such as allopurinol, might prevent PEP by inhibiting generation of oxygen-derived free radicals.…”

Section: Category 3: Markers Of Systemic Inflammationmentioning

confidence: 99%

Pancreatits after endoscopic retrograde cholangio-pancreatography

Aziz

Lehman

2007

WJG

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Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving nonselected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.© 2007 The WJG Press. All rights reserved.Key words: Endoscopic retrograde cholangiopancreatography; Post-ERCP pancreatitis Abdel Aziz AM, Lehman GA. Pacreatitis after endoscopic r e t r o g r a d e c h o l a n g i o -p a n c r e a t o g r a p h y . W o r l d J

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“…For example, in a study by Augustin et al (1994) in uveitis, a dose of allopurinol that was effective in blocking XO activity failed to affect the course of the disease, whereas higher doses of the compound (at which antioxidant effects become more prominent) proved effective in reducing the inflammation. The attempts to use allopurinol for anti-inflammatory purposes at the bedside have also failed so far: in a 300-patient study on pancreatitis developing as a complication of endoscopic retrograde cholangiopancreatog-THERAPEUTIC EFFECTS OF XANTHINE OXIDASE INHIBITORS raphy, allopurinol was found to be clinically ineffective (Budzynska et al, 2001).…”

Section: F Xanthine Oxidase and Inflammatory Bowel Disease And Othermentioning

confidence: 99%

Therapeutic Effects of Xanthine Oxidase Inhibitors: Renaissance Half a Century after the Discovery of Allopurinol

2006

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A Prospective, Randomized, Placebo-Controlled Trial of Prednisone and Allopurinol in the Prevention of ERCP-Induced Pancreatitis

Abstract: Neither prednisone nor allopurinol showed a beneficial influence on the incidence and severity of post-ERCP pancreatitis.

Cited by 95 publications

References 20 publications

Combination of allopurinol and hyperbaric oxygen therapy: A new treatment in experimental acute necrotizing pancreatitis?

Combination of allopurinol and hyperbaric oxygen therapy: A new treatment in experimental acute necrotizing pancreatitis?

Pancreatits after endoscopic retrograde cholangio-pancreatography

Therapeutic Effects of Xanthine Oxidase Inhibitors: Renaissance Half a Century after the Discovery of Allopurinol

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