Abstracts Category : Other

Antioxidants and Chronic Pancreatitis

by Nehal Sureshkumar Shah

ANTIOXIDANT THERAPY IN CHRONICPANCREATITISChronic pancreatitis (CP) is characterised by chronic,frequent, disabling abdominal pain. It often leads to exocrine andendocrine insufficiency resulting in malabsorption and diabetesmellitus respectively. The incidence of CP is 5-10 per 100,000population worldwide and is on the rise in UK.Alcohol (70%) is thecommonest aetiologic cause, idiopathic (20%) and others (10%) beingsecond and third respectively. There are various medical andsurgical treatment options available depending on clinicalcharacteristics and the stage of disease. In spite of wide spectrumof therapeutic options, pain control still remains a challengingproblem to the clinicians. Surgical treatments for chronicpancreatitis, broadly classified into resectional and drainageprocedures, may offer relief of symptoms. These surgeries areassociated with severe morbidity and high mortality. In addition,our comprehensive review of surgery in chronic pancreatitisdemonstrated lack of criteria for baseline assessment of patientswith CP; resulting in lack of standardization, variation inindication and comparability in published literature on surgicaltreatment of chronic pancreatitis. These factors have collectivelyforced the medical fraternity to look for other non or minimallyinvasive options. Oxidative stress and deficiency of anti-oxidantshave long been implicated in pathogenesis of CP. Our review ofliterature on oxidative stress and antioxidants has highlighted theshortcomings and inadequacies from the previously publishedreports. These reports were underpowered and not all includedpatients had chronic pancreatitis. This in turn led us to propose awell designed randomised, double blind, placebo controlled trial ofantioxidant therapy in CP. Considering the loss of time andproductivity, it is necessary to undertake Qol as an outcomemeasure in any intervention related to CP. Our study assessed thesuitability and feasibility of validated quality of life indices inpatients with painful chronic pancreatitis. After correction fordisease duration, the outcome of contemporary quality of lifeassessments showed that patients with CP taking Antox had betterscores than controls. Cytokines, a group of proteins andglycoproteins that act in regulation of immunity, inflammation andhaematopoiesis are implicated in oxidative stress relatedpathogenesis of chronic pancreatitis. They are broadly classed aspro-inflammatory and anti-inflammatory. There have been fewexperimental studies suggesting that antioxidants amelioratecytokine response in chronic pancreatitis. However our study hasfailed to demonstrate a significant effect on cytokine levels aftersix months of antioxidant therapy.Similarly, on the clinical front,a randomised, double blind placebo controlled study (referred to asANTICIPATE TRIAL) has shown no benefit of antioxidant therapy inpainful chronic pancreatitis, irrespective of age, gender,aetiology or operative intervention. So we are afraid to say thatuntil we discover any novelAdvisors/Committee Members: Siriwardena, Ajith.