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Most patients with chronic pancreatitis suffer from abdominal pain, often the most intransigent and debilitating symptom of the disease. Current treatments have shown limited effectiveness. The use of antioxidants has been the focus of several clinical trials, including a study in India that demonstrated improved pain symptoms with antioxidants (JW Gastroenterol Jul 24 2009).
To further investigate the efficacy of antioxidants, researchers conducted an industry-supported, randomized, placebo-controlled trial at a single center in the U.K. involving 92 patients with at least moderately severe pain occurring at least 7 days during the month prior to randomization. Patients received an antioxidant mixture (77 mg selenium yeast, 226.8 mg d-α-tocopherol, 252.6 mg ascorbic acid, 960 mg l-methionine, and 8.4 mg beta-carotene) 3 times daily or matching placebo for 6 months. Pain was scored on a visual analogue scale during the study visit and through a daily diary. Quality of life was assessed using four different validated instruments.
A total of 70 patients (76%) completed 6 months of therapy. Analyses of both pain scores and quality-of-life scores revealed no differences between groups.
Siriwardena AK et al. Antioxidant therapy does not reduce pain in patients with chronic pancreatitis: The ANTICIPATE study. Gastroenterology 2012 Sep; 143:655.
Comment
The current findings are at odds with those of the recent trial in India, which demonstrated a clinically significant benefit of antioxidant therapy. These disparate results might be attributable to the differences in the antioxidant mixtures used or the patient populations studied. Compared with the current study cohort, the Indian cohort was younger, smoked less, and had more idiopathic disease than pancreatitis of alcoholic origin (which characterized the majority of the U.K. cohort). Unfortunately — in the U.S. at least — most patients with chronic pancreatitis fit the profile of the U.K. cohort. Taken together, these trials do not provide sufficient evidence to support the routine use of antioxidants in patients with painful chronic pancreatitis.