Diclofenac Sodium Treatment Ameliorates Extrapancreatic Organ Injuries in a Murine Model of Acute Pancreatitis Induced by Caerulein

Abstract

Aim We determined the effects of diclofenac sodium, octreotide, and their combination on extrapancreatic organ injuries in caerulein-induced acute pancreatitis in mice. Methods A total of 58 BALB-C male mice (25 g) were divided into seven groups and used to create a caerulein-induced acute pancreatitis model. Diclofenac sodium, octreotide, and their combination were given for treatment of caerulin-induced acute pancreatitis in mice. At the end of the experiment, the lung, liver, kidney, and stomach were removed for histopathologic assessment. Results Histopathologic investigation revealed a statistically significant difference between the groups in mean congestion, edema, tubular injury, perirenal fat tissue inflammation, and tubular stasis scores in kidney tissue (P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.048, respectively); mean congestion, edema, neutrophil inflammation, mononuclear inflammation, and emphysematous change scores in the lung (P < 0.001, P < 0.001, P < 0.001, P = 0.030, and P < 0.001, respectively); mean congestion, edema, and neutrophil inflammation scores in the stomach (P = 0.008, P = 0.014, and P < 0.001, respectively); and mean congestion and hydropic degeneration scores in the liver (P = 0.029 and P = 0.002, respectively). Conclusion Diclofenac sodium alone ameliorates lung edema due to caerulin-induced acute pancreatitis.

A Systematic Review and Meta-analysis of Opioids vs Nonopioids in Acute Pancreatitis

“…30 Animal studies with diclofenac showed promising results with decreased pancreatic injury and decreased kidney, lung, and liver injury by reducing apoptosis and necrosis. 31,32 It was reported that 2 had acute kidney injury with diclofenac by Mahapatra et al, 15 but both these events could not be attributed to diclofenac. Four events of acute lung injury with diclofenac are seen which are less but significant when compared with 9 with tramadol.…”

Comparison of efficacy of diclofenac and tramadol in relieving pain in patients of acute pancreatitis: A randomized parallel group double blind active controlled pilot study

“…Both the groups were comparable in terms of safety parameters. Diclofenac is a non steroidal anti inflammatory agent (Ozer Cakir & Findik, 2018). The pancreato-protective effect of diclofenac alone and in combination with sublingual nitrates and somatostatin in post-ERCP acute pancreatitis is reported in many clinical studies (Katsinelos et al, 2012;Serrano et al, 2019;Tomoda et al, 2019).…”

“…Diclofenac administration was also associated with reduced extra‐pancreatic damage e.g. decreased kidney injury (Ozer Cakir & Findik, ), decreased peri‐nephric fat tissue inflammation (Ozer Cakir & Findik, ), lung injury (Bhatia et al, ; Ozer Cakir & Findik, ) and liver injury (Ozer Cakir & Findik, ). The protective effect of diclofenac is by enhancing LxA4, RvD1 and RvE1 levels (Zhao et al, ) and by inhibiting phospholipase‐A2 (Mäkelä, Kuusi, & Schröder, ).…”

“…Use of diclofenac was associated with reduced occurrence of post-ERCP pancreatitis highlighting its pancreato-protective property (Serrano et al, 2019). In preclinical animal studies, use of diclofenac is associated with decreased occurrence of pancreatic and extra-pancreatic complications associated with acute pancreatitis (Bhatia, Sidhapuriwala, Sparatore, & Moore, 2008;Ozer Cakir & Findik, 2018). However, till now diclofenac has not been evaluated in clinical setting for pain in AP.…”