Long-term pain relief with optimized medical including antioxidants and step-up interventional therapy in patients with chronic pancreatitis.
J Gastroenterol Hepatol. 2016 Apr 7;
Authors: S S, Midha S, Hasan A, Dhingra R, Garg PK
Abstract
BACKGROUND AND AIM: Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach.
METHODS: All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 ug organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure.
RESULTS: A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (p < 0.001). Of the 288 patients, 261, 218, 112 and 51 patients were followed up for 3, 5, 10 and 15 years respectively; 54.0%, 57.3%, 60.7% and 68.8% of them became pain free at those follow-up periods.
CONCLUSION: Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment. This article is protected by copyright. All rights reserved.
PMID: 27061119 [PubMed - as supplied by publisher]