Antioxidants

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Drug Watch: Antioxidant Therapy for Recurrent Pancreatitis

There is little to offer patients with recurrent pancreatitis in way

of treatment. These patients suffer considerable pain, and about the

only measure that will guarantee long-term pain relief is near-total

pancreatectomy - which carries the penalties of malabsorption and

brittle diabetes. Though the number of patients with chronic

pancreatitis will be small across the UK, there may be pockets of

relatively high prevalence, largely in deprived areas. These patients

will consume significant amounts of health service resources - even

more if near-total pancreatectomy is carried out. Any therapy which

can be shown to be effective in chronic pancreatitis will therefore

have an impact on healthcare provision.

Causes of pancreatitis

There is accumulating evidence that oxidant stress resulting from an

excess of pro-oxidant over antioxidant has a key role in acute

oedematous pancreatitis as well as painful exacerbations of chronic

disease. Cytokines like platelet activation factor (PAF) have also

been shown to be involved with development of the acute disease in

animal models, but it is likely that the prime insult which triggers

pancreatitis is oxidant stress.

Antioxidant therapy?

From this, it would seem likely that therapy with antioxidants should

help to prevent pancreatitis - especially recurrent pancreatitis. A

randomised, controlled, double-blind, double dummy, crossover study

from the Manchester Royal Infirmary has shown this to be the case.

Twenty patients with chronic pancreatitis (8 idiopathic, 7 alcoholic

and 5 idiopathic acute) entered the study in which micronutrient

antioxidant therapy was compared with placebo, each for a 20-week

period. Patients took six tablets of selenium Ace (Wassen

International) and eight tablets of methionine ( Medical Ltd) in

divided doses, giving a daily total of:

* 600 µg organic selenium

* 9000 IU beta-carotene

* 0.54 g vitamin C

* 270 IU vitamin E

* 2 g methionine

Results

This was a thorough and detailed study. The bare-bones of the results

were that while six patients had an attack while on placebo, not one

had an attack while on active medication. Pain scores were

significantly lower on active treatment than on placebo and at

baseline. The blood concentrations of a free radical 'marker' - the

percentage molar ratio of 9,11-linoleic acid to 9,12-linoleic acid -

were elevated at baseline and in patients on placebo, but was

normalised by active treatment.

Benefits and costs

Treatment would entail a maximum cost of about £15 a month (1990

prices), with possibly a 50% reduction after six months. This

financial outlay is small compared with the cost in terms of the

mortality, morbidity, narcotic use, malnutrition and brittle diabetes

of near-total pancreatectomy.

Reference:

S Uden et al. Antioxidant therapy for recurrent pancreatitis: placebo

controlled trial. Alimentary Pharmacology and Therapeutics 1990 4:

357-71.

Questions to be Answered

Q: What need is met by this therapy?

A: Treatment of patients with chronic or recurrent acute pancreatitis.

Q: What happens now?

A: Patients are treated with analgesics, or may go on to near-total

pancreatectomy resulting in malabsorption and diabetes.

Q: Is quality improved?

A: Yes - patients on this treatment do not have pain.

Q: What does the treatment cost?

A: Less than £15 per month per patient.

Q: Can cost savings be made?

A: Yes - though not quantified, the cost of treatment with

antioxidants is likely to be much less than present treatments.

Advice to Health Authorities and GPFHs

* Will increase quality and effectiveness.

* May result in reduced costs.

* Worth considering in specification.

Wirh love, hope and prayers,

Heidi

Heidi H. Hess

South Carolina Rep.

Southeastern Rep., PAI

Note: My advice or comments are based on personal experience or

opinion, and should not be substituted for professional medical

consultation.