A Randomized Controlled Trial of Antioxidant Supplementation for Pain Relief in Patients With Chronic Pancreatitis

Italian consensus guidelines for chronic pancreatitis

“…The parenteral administration of these vitamins is therefore indicated in patients with reduced serum levels or in the presence of clinical features of malabsorption. Only a single controlled clinical trial demonstrated that oral supplementation with antioxidants (selenium, beta-carotene, ascorbic acid, tocopherol) can be useful for the prevention of painful relapses [80]. The results of this study need to be confirmed.…”

Micronutrient ('Antioxidant') Therapy for Chronic Pancreatitis: Basis and Clinical Experience

“…Hence, useful measures in plasma/serum might include the percent oxidized ascorbic acid relative to total vitamin C (138); GSH coupled with y-GT activity (138); protein carbonyls (167); and allantoin, signifying oxidation of uric acid which, along with albumin, glucose and bilirubin constitute the bulk antioxidants. Convenient tests that measure 'total plasma antioxidant activity' by a commercial kit, or so-called 'TRAP' and 'FRAP' assays that have been used in clinical trials (10,80), are misleading in monitoring micronutrient therapy because they are largely influenced by those compounds : ascorbic acid contributes 20% to the FRAP reading, vitamin E 5%, β-carotene very little and thiols none (30). If a nomogram is available to monitor treatment (126,160), so much the better.…”

“…Since dysregulated methionine metabolism due to RXS seems to underlie most cases of chronic pancreatitis, an index of its repair by treatment would be very helpful -as by analysing a metabolite(s) (63,96,160) , and / or 11 C methionine scanning (150,153). These resources are scarce, but a sustained increase in erythrocyte GSH upon micronutrient therapy appears to be an indirect pointer (10). It is generally accepted that the identification of oxidative stress and its correction should involve more than a single index of attack on a single target (21).…”

“…The first independent appraisal of antioxidant therapy for pain control in patients with chronic pancreatitis covered reports on randomized controlled trials (RCT) up to 2009, and concluded that the identified micronutrient combination ( Section 3) improved outcome in each of three placebo-controlled studies (159,80,10), but that meta-analysis was impossible because different instruments were used to measure pain (104). In the past 12 months, three meta-analyses have appeared, covering studies until October '12 (1), December '12 (39), and February '14 (178).…”

“…Table 2 summarises information on studies of the micronutrient combination, whether (10,50,80,145,159,160) or not (48,162) placebocontrolled, excluding studies reported only in abstract. In the original cross-over trial clinical improvement was accompanied by migration of datapoints towards the control zone in the nomogram relating serum levels of a lipid oxidation marker and selenium (Figure 3) (160).…”