Antioxidant therapy for recurrent pancreatitis: placebo‐controlled trial

Abstract

SUMMARY Oxidant stress has been proposed as the initiating pathogenetic mechanism in pancreatitis, hence micronutrient antioxidant therapy has been assessed in patients with recurrent attacks and/or constant pancreatic pain. In a 20‐week double‐blind double‐dummy crossover trial active treatment was given as two types of tablets providing daily doses of 600 μg organic selenium, 9000 IU β carotene, 0.54 g vitamin C, 270 IU vitamin E and 2 g methionine. Of 28 patients enrolled, 20 adhered to the full protocol (idiopathic chronic 8, alcoholic chronic 7, idiopathic acute 5). Six patients had an attack whilst on placebo but none whilst on active treatment (P= 0.032). Analysis of visual analogue scoresheets to compare background pain in the 10‐week period before entry and during each phase of the trial, using a 10‐cm scale for each of 11 best descriptors, endorsed the beneficial effect of active treatment (placebo v baseline, P= 0.073; active v baseline, P < 0.001; active v placebo, P= 0.049). The same trend emerged from analysis of pain‐score diaries by conventional and time series methods. Micronutrient antioxidant therapy thus offers a new approach to the treatment of recurrent (non‐gallstone) pancreatitis and/or pancreatic pain.

Italian consensus guidelines for chronic pancreatitis

“…The results of this study need to be confirmed. Previous studies were negative or inconclusive [63,[81][82][83][84][85]. Though 80% consensus rate was reached, one in five participants agreed with major reservation only.…”

Major Sulphur Compounds in Plants and their Role in Human Nutrition and Health - An overview

“…As a methyl-donor, methionine helps prevent fatty liver disease and eventual cirrhosis of the lever (Richmond, 1986). Methionine is also reported to be effective in the treatment of Parkinson's disease (Smythies and Hasley, 1984) and acute pancreatitis (Uden et al, 1990). However, excessive methionine consumption can be harmful.…”

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

“…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).…”

“…Despite the indiscriminate inclusion of RCTs judged satisfactory on mechanistic grounds, without considering the basis for treatment or legitimacy, each report concluded that active treatment reduced pain, especially using the micronutrient combination (39), and that although side-effects in up to 19% were usually mild ( eg headache, nausea, allergy, constipation, diarrhoea), they did cause some patients to withdraw from the trial. The first trial, published in 1990 (159), was the only one to tick all the boxes in the report under the Cochrane banner (1) : an attempt to gauge quality-of-life used questionnaires based on patients with chronic backache, inappropriate in retrospect but the best available at the time. Interestingly, reports that were deemed fit for inclusion were not the same in these meta-analyses.…”

“…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).…”