Antioxidant Therapy Does Not Reduce Pain in Patients With Chronic Pancreatitis: The ANTICIPATE Study

Siriwardena, Ajith K.; Mason, James; Sheen, Aali J.; Makin, Alistair; Shah, Namrata

doi:10.1053/j.gastro.2012.05.046

Cited by 114 publications

(91 citation statements)

References 19 publications

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“…72 However, the recent completion of the ANTI-Oxidant therapy for painful Chronic Pancreatitis Therapy Evaluation (ANTICIPATE) study concluded that patients with painful chronic pancreatitis of alcoholic origin did not experience a reduction in pain or improvement in quality of life with combined antioxidant therapy, despite a sustained increase in blood levels of the antioxidants. 73 The authors mentioned that their cohort consisted of older patients (median 50 years versus 30 years in the study by Bhardwaj et al) who likely had irreversible pancreatic damage that could not be modified by antioxidant supplementation. 72 These findings are similar to the results obtained by Burton et al who found that administration of antioxidants was more effective in younger patients and those with a pancreatitis etiology secondary to idiopathic and obstructive versus alcoholic pancreatitis.…”

Section: Antioxidants and Herbal Supplementsmentioning

confidence: 99%

Nutritional advice for prevention of acute pancreatitis: review of current opinion

Lowe¹,

Sevilla²

2012

NDS

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Pancreatitis is inflammation of the pancreas that can be acute and self-limiting or, in a small percentage of patients, recurrent. Patients with recurrent episodes of acute pancreatitis (RAP) often progress to chronic pancreatitis. Pancreatitis in all forms causes significant economic and social burdens. Prevention of RAP may decrease those burdens and halt progression to chronic disease. Unfortunately, no therapy has proven effective at altering the course of RAP. While enteral nutritional therapy plays an important role in the treatment of acute pancreatitis during episodes, nutritional advice provided to patients in an attempt to prevent recurrent episodes has not proven effective in most cases. Discontinuing alcohol consumption and treating dyslipidemia with diet and medication can help patients with these issues. In patients whose pancreatitis is associated with celiac disease or eosinophilic gastroenteritis, a gluten-free diet and avoidance of food allergens can be effective in stopping RAP. Advice to take pancreatic enzyme replacement therapy, lose weight, control diabetes, decrease dietary sucrose, decrease dietary fat or avoid monosodium glutamate has little to no evidence of efficacy. Some studies suggest that an antioxidant cocktail may decrease the frequency of RAP and the intensity of chronic pain, but the evidence is weak. Nutritional therapy may have a role in the treatment of patients with RAP. At present, there are no clear guidelines for nutritional advice to give these patients. More studies are needed to identify nutritional interventions that will benefit patients with RAP.

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Section: Antioxidants and Herbal Supplementsmentioning

confidence: 99%

Nutritional advice for prevention of acute pancreatitis: review of current opinion

Lowe¹,

Sevilla²

2012

NDS

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“…Antioxidant treatment is a strategy to treat pain in chronic pancreatitis. There are conflicting data, however, whether a 5-component antioxidant cocktail (containing selenium, beta-carotene, vitamin C, vitamin E, and methionine) reduces pain in chronic pancreatitis (37)(38)(39)) but there appears to be a modest reduction in the frequency of pain in patients with deficiencies of antioxidants and/ or antioxidant-scavenging enzymes and increased markers of oxidative stress (37). Targeting PPAR gamma signaling could potentially simultaneously treat multiple pancreatic (and perhaps extra-pancreatic) derangements, in part due to interactions between the endocrine and exocrine pancreas; in a nonobese model of insulin resistance, PPAR-gamma treatment abolished impairments of both pancreatic endocrine function (insulin resistance) and pancreatic exocrine function in mice (40).…”

Section: S41 Role Of Cftr In Normal Exocrine Pancreatic Functionmentioning

confidence: 99%

Symposium Summaries

2015

Pediatric Pulmonology

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Diabetes is a chronic metabolic disease with over 300 million people suffering worldwide. Insulin insufficiency is found in type 1 diabetes and, combined with insulin resistance, in type 2 diabetes. Although the cause of insulin insufficiency is generally considered to be a result of β-cell damage by autoimmunity, a high percentage of diabetic patients with insulin insufficiency show negative of those autoantibodies. Up to 50% adult patients with cystic fibrosis (CF), a disease caused by mutations in the gene encoding the CF transmembrane conductance regulator (CFTR), develop CF-related diabetes (CFRD) with most patients exhibiting insulin insufficiency. Our recent studies have explored the possible involvement of CFTR in regulating the electrophysiological activities of pancreatic β cells required for insulin secretion. The results show that the glucose-elicited whole-cell currents, membrane depolarization, electrical bursts or action potentials, Ca 2+ oscillations and insulin secretion are abolished or reduced by inhibitors or knockdown of CFTR in primary mouse β-cells or RINm5F β-cell line, or significantly attenuated in CFTR mutant (ΔF508) mice compared with wild-type mice. VX-809, a newly discovered corrector of ΔF508 mutation, successfully rescues the defects in ΔF508 β-cells. Our results reveal a role of CFTR in glucose-induced electrical activities and insulin secretion in β-cells, and shed light on the pathogenesis of CFRD and possibly other idiopathic diabetes. S1.2 CFTR AND AIRWAY HOST DEFENSE IN THE CF PIG MODELMahmoud H. Abou Alaiwa, M.D. Internal Medicine, University of Iowa, Iowa City, IA, USAAirways evolved with multiple host defense mechanisms to protect against invading organisms (1-4). At the interface with the environment is a thin layer of airway surface liquid (ASL) equipped with antimicrobial factors that rapidly kill bacteria and mucus that rapidly clears trapped pathogens (5). Cystic fibrosis (CF) lung disease is characterized by recurrent bacterial airway infections, accumulation of mucus, inflammation, and progressive decline in lung function. Despite advances in antibiotic formulations and mucus mobilization maneuvers, CF lung disease continues as the leading cause of morbidity and mortality in people with CF (6). Development of the CF pig and other animal models has added understanding of the pathogenesis of early CF airway disease (7, 8). At birth, CF pig lungs show no inflammation or infection but demonstrate a bacterial host defense defect. Over time, CF pigs spontaneously develop the hallmark features of CF airway disease with infection, inflammation, airway obstruction and airway remodeling (9). We examined CF pigs within hours of birth and discovered two host defense defects. First, CF ASL is abnormally acidic, which inhibits the activity of antimicrobial peptides and proteins (10). This low ASL pH not only affects the antimicrobial activity of individual antimicrobial factors, but also their synergistic interactions (11). Second, impaired anion secretion by CF submucosal gland...

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“…Although there are international and national guidelines for the management of chronic pancreatitis, the evidence for selection of suitable treatment modalities is less clear [1]. In terms of baseline treatments, there is a series of relatively small randomised trials evaluating treatments such as the role of alcohol avoidance counselling in preventing re-admission in the early stages of the disease, gabapentin for symptom control and micronutrient antioxidant therapy [2-4]. In terms of further treatment, there are small randomised trials comparing endoscopic treatment to surgical intervention, but a large part of the body of evidence on either endoscopic or surgical treatment derives from case series reporting outcome [5-6].…”

Section: Introductionmentioning

confidence: 99%

The Practical Management of Chronic Pancreatitis: A Multidisciplinary Symposium Held at the Annual Meeting of the Pancreatic Society of Great Britain and Ireland, Manchester 2016

Jegatheeswaran¹,

Puleston

Duggan

et al. 2018

Dig Surg

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Aim: This study is about a questionnaire survey of delegates attending the chronic pancreatitis symposium at the 2016 meeting of the Pancreatic Society of Great Britain and Ireland and seeks a multidisciplinary “snapshot” overview of practice. Methods: A questionnaire was developed with multidisciplinary input. Questions on access to specialist care, methods of diagnosis and treatment including specific scenarios were incorporated. Eighty-three (66%) of 125 delegates effectively participated in this survey. Results: Twenty-four (29%) had neither a chronic pancreatitis MDT in their hospital nor a chronic pancreatitis referral MDT. Most frequently utilised diagnostic modalities were CT, MR and EUS with no respondents utilising duodenal intubation tests. Initial treatment was provided through non-opiate analgesia by 69 (93%), through the use of opiates by 56 (76%) and through the use of co-analgesics by 49 (66%). Fifty two (68%) routinely referred patients with alcohol-related disease for counselling. Preferred treatment for large duct disease without mass was endoscopic therapy. In older patients with a mass, pancreaticoduodenectomy was preferred. Conclusion: This is a small study likely to be skewed by sampling bias but is thought to be the first multidisciplinary survey of the management of chronic pancreatitis in the United Kingdom and Ireland. The results show a need for comprehensive access to specialist pancreatitis MDT care and there remains substantial variation in management.

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Antioxidant Therapy Does Not Reduce Pain in Patients With Chronic Pancreatitis: The ANTICIPATE Study

Cited by 114 publications

References 19 publications

Nutritional advice for prevention of acute pancreatitis: review of current opinion

Nutritional advice for prevention of acute pancreatitis: review of current opinion

Symposium Summaries

The Practical Management of Chronic Pancreatitis: A Multidisciplinary Symposium Held at the Annual Meeting of the Pancreatic Society of Great Britain and Ireland, Manchester 2016

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