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

Abstract

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.

Enzymatic Debridement in Necrotizing Pancreatitis

“…Indeed there is data on successful results achieved by administering allopurinol into the peritoneal cavity of experimental animals with formed acute necrotizing pancreatitis. 15 It is possible to object to this group when one considers that the effect of allopurinol is different from that of Sterile Novuxol (Abbott). But the other reason for forming this group was to investigate the effects of the toxicity of Sterile Novuxol (Abbott) on peritoneal and abdominal viscera.…”

Allopurinol in Dermatology

“…[6] Recent evidence suggests that allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not by lowering uric acid. [7] Animal experiments have also suggested that allopurinol exerts positive effects in the treatment of major intra-abdominal surgery, [8] acute necrotizing pancreatitis, [9] chronic pancreatitis, [10] as well as in the prevention of esophageal stricture from caustic burn. [11] Diabetic rats treated with allopurinol showed improved nerve and vascular function.…”

Sterile Inflammatory Response in Acute Pancreatitis

“…Allopurinol decreases pancreatic injury in experimental AP and has been shown to decrease the incidence of post-ERCP pancreatitis in a randomized controlled trial. 61, 62 …”