Combined Antioxidant Therapy Reduces Pain and Improves Quality of Life in Chronic Pancreatitis

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.…”

“…Statement (EL 1b − RG B): Structured questionnaires are useful to evaluate the well-being of patients with chronic pancreatitis. Consensus Levels of Agreement: A+ 50%; A 31.3%; A− 12.5%; D− 6.3%; D 0%; D+ 0% Many structured questionnaires have been utilized to assess the well-being of patients with chronic pancreatitis [20,27,[61][62][63][64][65][66][67][68][69]. SF-12, SF-36, EORTC QLQ C-30, and GIQLI have all been proved useful.…”

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.…”

“…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).…”