Bhardwaj P, Garg PK, Maulik SK et al.
All India Institute of Medical Sciences, New Delhi, India.
Gastroenterology 2009;136:149.e2–59.e2.
Editor’s note: Patients with chronic pancreatitis experience pain that is difficult to treat, and this often leads to a vicious cycle of opiate dependence. While a minority of patients may benefit from surgery to decompress a dilated pancreatic duct, for most there is no satisfactory treatment. As in most chronic inflammatory conditions, oxidative stress can be demonstrated in the chronically scarred and inflamed pancreas. Some reports from animal models and small clinical trials have suggested that antioxidants may be beneficial in reducing inflammation and pain. Therefore, Bhardwaj and colleagues embarked upon a large, randomized, placebo-controlled trial to compare the effects of anti-oxidants (including daily doses of selenium, ascorbic acid,
β-carotene, and methionine in a single preparation) with placebo in
>100 patients with chronic pancreatitis. Because the study was conducted in New Delhi, India, the etiologies of most of the patients was idiopathic (or “tropical”) and the majority of subjects were aged <40 years. Pain was evaluated through pain diaries and analgesic consumption during a run-in period of 3 months, and monthly for6 months throughout the study.