- Email: [email protected]
Long-term effect of micronutrient antioxidant therapy on pain and opiate use in chronic pancreatitis
S102
Abstracts / Pancreatology 14 (2014) S1eS129
Background: Persistent organ failure and infected pancreatic necrosis are major determinants of mortality in acute pancreatitis. There is a gap in the literature assessing best predictors of these determinants. Aims: The purpose was to determine the utility of predictors of persistent organ failure and infected pancreatic necrosis in patients with acute pancreatitis, both individually and in combination. Patients & methods: Systematic search of literature in EMBASE, Cochrane Reviews, PubMed 1950 - January 2013 for prospective studies evaluating predictors of persistent organ failure, infected pancreatic necrosis, or both. Results: 526 studies examined predictors of persistent organ failure. Eight studies examining 15 predictors met criteria. The best predictors within 48h of admission: Japanese Severity Score, BISAP, Glasgow score. After 48 hours: blood urea nitrogen, Japanese Severity Score. 1,118 studies examined predictors of infected pancreatic necrosis. 18 papers examining 17 predictors met criteria. Best predictor of infected pancreatic necrosis was procalcitonin. One study examined predictors of both persistent organ failure and infected pancreatic necrosis. It found procalcitonin had higher accuracy at prediction of critical acute pancreatitis. Conclusion: There are only a limited number of high quality studies evaluating predictors of persistent organ failure and/or infected pancreatic necrosis. Based on the best available data, it is justifiable to use blood urea nitrogen for prediction of persistent organ failure after 48 hours of admission and procalcitonin for prediction of infected pancreatic necrosis in patients with confirmed pancreatic necrosis. There is no predictor of persistent organ failure that can be justifiably used in clinical practice within 48 hours of admission.
Background: There is no effective medical therapy for chronic pancreatitis (CP) and micronutrient antioxidant therapy has been proposed to reduce oxidative stress at the acinar level. Although the ANTICIPATE trial showed no benefit from antioxidant therapy, the study only examined treatment for 6 months. Longer-term treatment may be required to modulate chronic disease. Aims: To assess pain and opiate requirement in a longitudinal followup study of patients with CP on micronutrient antioxidant therapy. Patients & methods: Case notes of patients with CP having their first inpatient episode during the 8 years to 1st January 1998 were identified from hospital final diagnosis codes (ICD 10 K86.1 and K86.0). A retrospective case note review of a non-consecutive series of 30 patients (19 [63%] male) diagnosed contemporaneously as having CP and treated with micronutrient methionine, selenium, vitamin C-based antioxidant therapy. Patients were followed for 10 years or until antioxidant therapy was stopped. Results: The most common aetiology was alcohol (21[70%]). Median (range) follow-up in months was 46 (12-120). At presentation 20(67%) had abdominal pain and at last follow-up 17(57%) reported pain (P¼ 0.596; Fisher’s exact). 10 (33%) were on opiate analgesia at the start of the study and 11 (36%) (P¼1.00; Fisher’s exact) at the end. There were no treatmentrelated complications and no selenium-related malignancy. Conclusion: Although a small cohort, this is the first report of the longterm use of micronutrient antioxidant therapy in CP. Accepting the risk of type II error, there appears to be no effect of therapy on relief of pain or opiate requirements.
F-054. F-052. Acute pancreatitis in cystic fibrosis
Changes of bile composition in patients with chronic pancreatitis Inna Kovalska a, Oleksiy Dronov a, Tetyana Beregova b, Yuriy Schvets a a
Clare E. Pearson, Valia Kehagia, Thomas WV. Daniels, Mary P. Carroll, Fanny W. Shek University Hospital Southampton NHS Foundation Trust, United Kingdom Background: Acute Pancreatitis(AP) is a uncommon complication in patients with Cystic Fibrosis(CF). This has been reported in young adult pancreatic sufficient(PS) CF patients. Aims: We aim to investigate the incidence and characteristics of AP in Southampton Regional CF Unit. Patients & methods: We retrospectively identified CF patients with clinical symptoms of AP and had elevated serum amylase>120iu/L. Dermographic characteristics such as genotype, age of CF diagnosis and first episodes of AP, BMI, diabetic status, pancreatic status(PS defined by faecal elastase levels <200mcg/g stools), occurence of relases were collected. Results: We identified 7 patients (6 female) with AP in a CF population of 185(3.8%), similar to previous studies. Apart from 1 patient, CF diagnoses were made in adolescence/adulthood. All cases had mild CF phenotype. Paradoxically, these patients had a high mean BMI 29kg/m2(range 20-41kg/ m2), 1(1/7) patient had impaired glucose tolerance. The first episode of AP occurred at a mean age of 34 years(23-50). The mean serum amylase level at the time of pancreatitis was 792iu/L(176-2911iu/L), with 3 patients subsequently becoming pancreatic insufficient(PI). the use of Pancreatic Enzyme Replacement Therapy(PERT) reduced the furhter incidence of abdominal pain. In 2 cases, Botulinum Toxin Type A injections on the Sphincter of Oddi have reduced further AP attacks. Conclusion: Our study has shown that it is important to recognise AP in CF patients and it can lead to PI. Moreover, treating with PERT and in some cases Botulinum Toxin can help in reducing recurrent episodes of AP.
b
Bogomolets National Medical University, Ukraine Taras Shevchenko National University of Kyiv, Ukraine
Background: The frequency of chronic fibrotic pancreatitis (CFP) has increased twice during the latest 30 years. Complications of CFP lead to changes in absorption and parietal digestion, and dismetabolism of proteins, lipids and carbohydrates as a consequence. Aims: The aim of the study was to analyze the changes in composition of liver bile in patients with CFP and to investigate the effect of those changes on further pathogenesis of the disease. Patients & methods: Bile samples from 60 persons were investigated. Among them 20 healthy persons, 20 patients with CFP without and 20 patients with CFP with obstructive jaundice (CFPOJ). Thin-layer chromatography was used to detect levels of bile acids and lipids of bile. Flame photometry was used to detect levels of electrolytes in bile samples. Results: Concentration of taurocholic acid was 33% lower in bile of CFP patients then in healthy people (p<0.001), at the same time this marker was 88% higher (p<0.001) in patients with CFPOJ then in healthy people and 185% higher then in CFP patients (p<0.001). Similar trend was noticed in concentration of glycocholic acid, taurochenodeoxicholic and taurodeoxicholic acid complex and chenodeoxicholic and deoxicholic acids. Sodium concentration was significantly higher in bile of patients with CFPOJ then in CFP group, and significantly higher in CFP group then in healthy people. No significant changes in potassium concentration were found. Conclusion: The changes investigated allow development of new diagnostic markers and correction of medication in patients with CFP and CFPOJ.
F-055. F-053. Long-term effect of micronutrient antioxidant therapy on pain and opiate use in chronic pancreatitis Sukitha N. Rupasinghe, Santhalingam Jegatheeswaran, Ajith K. Siriwardena HPB Unit, Manchester Royal Infirmary, United Kingdom
Circulatory biomarkers for the differential diagnosis of pancreatic cancer and chronic pancreatitis Anthony Evans, Claire Jenkinson, William Greenhalf, John Neoptolemos, Eithne Costello Department of Molecular and Clinical Cancer Medicine, University of Liverpool, United Kingdom
Abstracts / Pancreatology 14 (2014) S1eS129
Background: Persistent organ failure and infected pancreatic necrosis are major determinants of mortality in acute pancreatitis. There is a gap in the literature assessing best predictors of these determinants. Aims: The purpose was to determine the utility of predictors of persistent organ failure and infected pancreatic necrosis in patients with acute pancreatitis, both individually and in combination. Patients & methods: Systematic search of literature in EMBASE, Cochrane Reviews, PubMed 1950 - January 2013 for prospective studies evaluating predictors of persistent organ failure, infected pancreatic necrosis, or both. Results: 526 studies examined predictors of persistent organ failure. Eight studies examining 15 predictors met criteria. The best predictors within 48h of admission: Japanese Severity Score, BISAP, Glasgow score. After 48 hours: blood urea nitrogen, Japanese Severity Score. 1,118 studies examined predictors of infected pancreatic necrosis. 18 papers examining 17 predictors met criteria. Best predictor of infected pancreatic necrosis was procalcitonin. One study examined predictors of both persistent organ failure and infected pancreatic necrosis. It found procalcitonin had higher accuracy at prediction of critical acute pancreatitis. Conclusion: There are only a limited number of high quality studies evaluating predictors of persistent organ failure and/or infected pancreatic necrosis. Based on the best available data, it is justifiable to use blood urea nitrogen for prediction of persistent organ failure after 48 hours of admission and procalcitonin for prediction of infected pancreatic necrosis in patients with confirmed pancreatic necrosis. There is no predictor of persistent organ failure that can be justifiably used in clinical practice within 48 hours of admission.
Background: There is no effective medical therapy for chronic pancreatitis (CP) and micronutrient antioxidant therapy has been proposed to reduce oxidative stress at the acinar level. Although the ANTICIPATE trial showed no benefit from antioxidant therapy, the study only examined treatment for 6 months. Longer-term treatment may be required to modulate chronic disease. Aims: To assess pain and opiate requirement in a longitudinal followup study of patients with CP on micronutrient antioxidant therapy. Patients & methods: Case notes of patients with CP having their first inpatient episode during the 8 years to 1st January 1998 were identified from hospital final diagnosis codes (ICD 10 K86.1 and K86.0). A retrospective case note review of a non-consecutive series of 30 patients (19 [63%] male) diagnosed contemporaneously as having CP and treated with micronutrient methionine, selenium, vitamin C-based antioxidant therapy. Patients were followed for 10 years or until antioxidant therapy was stopped. Results: The most common aetiology was alcohol (21[70%]). Median (range) follow-up in months was 46 (12-120). At presentation 20(67%) had abdominal pain and at last follow-up 17(57%) reported pain (P¼ 0.596; Fisher’s exact). 10 (33%) were on opiate analgesia at the start of the study and 11 (36%) (P¼1.00; Fisher’s exact) at the end. There were no treatmentrelated complications and no selenium-related malignancy. Conclusion: Although a small cohort, this is the first report of the longterm use of micronutrient antioxidant therapy in CP. Accepting the risk of type II error, there appears to be no effect of therapy on relief of pain or opiate requirements.
F-054. F-052. Acute pancreatitis in cystic fibrosis
Changes of bile composition in patients with chronic pancreatitis Inna Kovalska a, Oleksiy Dronov a, Tetyana Beregova b, Yuriy Schvets a a
Clare E. Pearson, Valia Kehagia, Thomas WV. Daniels, Mary P. Carroll, Fanny W. Shek University Hospital Southampton NHS Foundation Trust, United Kingdom Background: Acute Pancreatitis(AP) is a uncommon complication in patients with Cystic Fibrosis(CF). This has been reported in young adult pancreatic sufficient(PS) CF patients. Aims: We aim to investigate the incidence and characteristics of AP in Southampton Regional CF Unit. Patients & methods: We retrospectively identified CF patients with clinical symptoms of AP and had elevated serum amylase>120iu/L. Dermographic characteristics such as genotype, age of CF diagnosis and first episodes of AP, BMI, diabetic status, pancreatic status(PS defined by faecal elastase levels <200mcg/g stools), occurence of relases were collected. Results: We identified 7 patients (6 female) with AP in a CF population of 185(3.8%), similar to previous studies. Apart from 1 patient, CF diagnoses were made in adolescence/adulthood. All cases had mild CF phenotype. Paradoxically, these patients had a high mean BMI 29kg/m2(range 20-41kg/ m2), 1(1/7) patient had impaired glucose tolerance. The first episode of AP occurred at a mean age of 34 years(23-50). The mean serum amylase level at the time of pancreatitis was 792iu/L(176-2911iu/L), with 3 patients subsequently becoming pancreatic insufficient(PI). the use of Pancreatic Enzyme Replacement Therapy(PERT) reduced the furhter incidence of abdominal pain. In 2 cases, Botulinum Toxin Type A injections on the Sphincter of Oddi have reduced further AP attacks. Conclusion: Our study has shown that it is important to recognise AP in CF patients and it can lead to PI. Moreover, treating with PERT and in some cases Botulinum Toxin can help in reducing recurrent episodes of AP.
b
Bogomolets National Medical University, Ukraine Taras Shevchenko National University of Kyiv, Ukraine
Background: The frequency of chronic fibrotic pancreatitis (CFP) has increased twice during the latest 30 years. Complications of CFP lead to changes in absorption and parietal digestion, and dismetabolism of proteins, lipids and carbohydrates as a consequence. Aims: The aim of the study was to analyze the changes in composition of liver bile in patients with CFP and to investigate the effect of those changes on further pathogenesis of the disease. Patients & methods: Bile samples from 60 persons were investigated. Among them 20 healthy persons, 20 patients with CFP without and 20 patients with CFP with obstructive jaundice (CFPOJ). Thin-layer chromatography was used to detect levels of bile acids and lipids of bile. Flame photometry was used to detect levels of electrolytes in bile samples. Results: Concentration of taurocholic acid was 33% lower in bile of CFP patients then in healthy people (p<0.001), at the same time this marker was 88% higher (p<0.001) in patients with CFPOJ then in healthy people and 185% higher then in CFP patients (p<0.001). Similar trend was noticed in concentration of glycocholic acid, taurochenodeoxicholic and taurodeoxicholic acid complex and chenodeoxicholic and deoxicholic acids. Sodium concentration was significantly higher in bile of patients with CFPOJ then in CFP group, and significantly higher in CFP group then in healthy people. No significant changes in potassium concentration were found. Conclusion: The changes investigated allow development of new diagnostic markers and correction of medication in patients with CFP and CFPOJ.
F-055. F-053. Long-term effect of micronutrient antioxidant therapy on pain and opiate use in chronic pancreatitis Sukitha N. Rupasinghe, Santhalingam Jegatheeswaran, Ajith K. Siriwardena HPB Unit, Manchester Royal Infirmary, United Kingdom
Circulatory biomarkers for the differential diagnosis of pancreatic cancer and chronic pancreatitis Anthony Evans, Claire Jenkinson, William Greenhalf, John Neoptolemos, Eithne Costello Department of Molecular and Clinical Cancer Medicine, University of Liverpool, United Kingdom