beta-carotene and Pancreatitis

Patients with chronic pancreatitis (CP) typically suffer intractable abdominal pain that is resistant to most analgesic strategies. Recent research indicates that the pain of CP may be in part due to oxygen free radical induced pancreatic damage. Using a randomized, double-blind, placebo-controlled crossover trial, we evaluated the efficacy of a combined antioxidant preparation in the management of CP. Patients with confirmed chronic pancreatitis (N = 36) were randomized to receive treatment with either Antox, which contains the antioxidants selenium, betacarotene, L-methionine, and vitamins C and E, or placebo for 10 weeks. Each group of patients then switched to receive the alternative treatment for a further 10 weeks. Markers of antioxidant status were measured by blood sampling, whereas quality of life and pain were assessed using the SF-36 questionnaire. Nineteen patients completed the full 20 weeks of treatment. Treatment with Antox was associated with significant improvements in quality of life in terms of pain (+17 antioxidant vs. -7 placebo), physical (+9 vs. -3) and social functioning (+8 vs. -7), and general health perception (+10 vs. -3). We conclude that treatment with antioxidants may improve quality of life and reduce pain in patients suffering from chronic pancreatitis.

Topics: Abdominal Pain; Adult; Aged; Antioxidants; Ascorbic Acid; Attitude to Health; beta Carotene; Chronic Disease; Cross-Over Studies; Double-Blind Method; Drug Combinations; Female; Follow-Up Studies; Humans; Male; Methionine; Middle Aged; Pain Measurement; Pain, Intractable; Pancreatitis; Placebos; Quality of Life; Selenium; Treatment Outcome; Vitamin E

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used procedure. Pancreatitis is its most common complication. As the injury may be mediated by oxidative stress, it could be ameliorated by antioxidants.. We conducted a double-blind trial, giving the patients a single dose of natural beta-carotene or placebo, 12 hours prior to procedure, and monitoring them for 24 hours post-procedure for procedure complications, antioxidant levels, and plasma oxidation.. The overall incidence of acute pancreatitis according to our definition was 9.6%. The incidence of pancreatitis was not significantly different between the beta-carotene group (10%) and the placebo group (9.4%). Four patients in the placebo group had severe pancreatitis (2.22%), but none in the beta-carotene group. This difference is statistically significant.. We did not see a reduction in the incidence of post-ERCP pancreatitis, but there may be some protective effect of treatment with beta-carotene regarding the severity of disease.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Amylases; Antioxidants; beta Carotene; Biomarkers; Cholangiopancreatography, Endoscopic Retrograde; Double-Blind Method; Female; Humans; Incidence; Length of Stay; Lipid Peroxidation; Male; Middle Aged; Oxidative Stress; Pancreatitis; Phagocytosis; Premedication; Risk Factors; Severity of Illness Index; Treatment Failure; Vitamin A; Vitamin E

To observe outcome in a cohort of patients with severe acute pancreatitis receiving multiple anti-oxidant therapy.. An observational study was carried out in 46 consecutive patients with acute pancreatitis fulfilling current Atlanta consensus criteria for severe disease. All patients received multiple anti-oxidant therapy based on intravenous selenium, N-acetylcysteine and ascorbic acid plus beta-carotene and alpha-tocopherol delivered via nasogastric tube. Principal outcomes were the effect of anti-oxidant supplementation on anti-oxidant levels, morbidity and mortality in patients on anti-oxidant therapy, case-control analysis of observed survival compared to predicted survival derived from logistic organ dysfunction score (LODS), logistic regression analysis of factors influencing outcome and side effect profile of anti-oxidant therapy.. Paired baseline and post-supplementation data were available for 25 patients and revealed that anti-oxidant supplementation restored vitamin C (P = 0.003) and selenium (P = 0.028) toward normal. In univariate survival analysis, patient survival to discharge was best predicted by admission APACHE-II score with relative risk of death increasing 12.6% for each unit increase (95% CI 6.0% to 19.6%). The mean LODS calculated on admission to hospital was 3.7 (standard error of the mean 4.1) giving a predicted mortality for the cohort of 21%. The observed in-hospital mortality was 43%.. Case-control analyses do not appear to demonstrate any benefit from the multiple anti-oxidant combination of selenium, N-acetylcysteine and ascorbic acid in severe acute pancreatitis.

Topics: Acetylcysteine; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; alpha-Tocopherol; Antioxidants; Ascorbic Acid; beta Carotene; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Oxidative Stress; Pancreatitis; Selenium; Survival Rate

To investigate the correlation of nitric oxide (NO) and other free radicals with the severity of acute pancreatitis (AP) and complicated systemic inflammatory response syndrome (SIRS).. Fifty AP patients (24 simple AP patients and 26 patients with AP complicated by SIRS) were involved in the study. Fifty healthy volunteers were included as controls. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were evaluated, and plasma NO, plasma lipid peroxides, plasma vitamin E, plasma beta-carotene, whole-blood glutathione (GSH), and the activity of plasma GSH peroxidase were measured.. Compared with the control group, the APACHE II scores heightened in the AP group, and the SIRS group had the highest APACHE II scores (P < 0.005, P < 0.001, respectively). Plasma NO and plasma lipid peroxides increased with the heightening APACHE II scores, demonstrating a significant linear positive correlation (r = 0.618, r = 0.577, respectively; P < 0.001). Plasma vitamin E, plasma beta-carotene, whole-blood GSH, and the activity of plasma GSH peroxidase decreased with the heightening APACHE II scores, demonstrating a significant linear negative correlation (r = -0.600, r = -0.609, r = -0.559, r = -0.592, respectively; P < 0.001).. Nitric oxide and other free radicals take part in the aggravation of oxidative stress and oxidative injury and may play important roles in the pathogenesis of AP and SIRS. It may be valuable to measure free radicals to predict the severity of AP.

Topics: Acute Disease; Adolescent; Adult; Aged; APACHE; beta Carotene; Child; Female; Free Radicals; Glutathione Peroxidase; Humans; Linear Models; Lipids; Male; Middle Aged; Nitric Oxide; Pancreatitis; Severity of Illness Index; Systemic Inflammatory Response Syndrome; Vitamin E; Young Adult

Biochemical assessments of micronutrient antioxidant status were done in 14 consecutive black patients with calcific chronic pancreatitis and 15 controls at Soweto, near Johannesburg in southern Africa. The patients showed subnormal levels of vitamin C in plasma; selenium, beta-carotene and alpha-tocopherol in serum; and inorganic sulphate (as an index of long-term sulphur amino acid intake) in urine (P < 0.001 for each): furthermore, among the patients ascorbate constituted a lower fraction of vitamin C (P < 0.002), indicating heightened oxidation of the bioactive form. By comparing the results in Sowetan controls with reference ranges from Manchester, UK, the markedly lower vitamin C and, hence, ascorbate levels in the Sowetans was underlined (P < 0.001) and their selenium levels were also lower (P < 0.001), but beta-carotene, alpha-tocopherol and inorganic sulphate levels were comparable. The very low bioavailability of ascorbate among Sowetan controls is reminiscent of our previous finding in outwardly healthy people at Madras in southern India: in both these areas chronic pancreatitis is currently endemic, has a propensity to pancreatic calculi and runs a virulent course towards premature death from diabetes, malnutrition or pancreatic cancer. Considering that low ascorbate levels are a feature in patients with chronic pancreatitis who develop pancreatic calculi at Manchester and that antioxidant supplements ameliorate painful symptoms, we suggest that poor antioxidant intake may predispose underprivileged tropical communities to the disease. If so, there could be an opportunity for prophylaxis through a daily tablet containing vitamin C, perhaps along with selenium at Soweto and beta-carotene at Madras.

Topics: Adult; Antioxidants; Ascorbic Acid; beta Carotene; Black People; Carotenoids; Chronic Disease; Female; Humans; Male; Micronutrients; Middle Aged; Pancreatitis; Reference Values; Selenium; South Africa; Sulfates; Vitamin E

The value of serum beta-carotene concentration as an indicator of steatorrhoea was investigated in 50 patients with steatorrhoea (fecal fat greater than 7 g/day), 53 controls, and 22 patients with gastrointestinal disease without steatorrhoea. In the control group, beta-carotene concentrations were normally distributed when plotted logarithmically. The mean value was 131 micrograms/dl. The lower limit of normal, based on a 2-SD confidence interval, was 47 micrograms/dl. beta-Carotene concentrations and fecal fat excretion were correlated in a reciprocal, hyperbolic function (r = -0.66). Twenty-nine of the 50 patients with steatorrhoea had beta-carotene concentrations less than 47 micrograms/dl (sensitivity 58%; specificity 93%). Referring to an additional cut-off point of 100 micrograms/dl, beta-carotene concentration had a sensitivity of 88%. These data show that low plasma beta-carotene concentrations (less than 47 micrograms/dl) can be regarded a specific and useful indicator of steatorrhoea and thus obviate fecal fat analysis. Values greater than 47 micrograms/dl, however do not exclude steatorrhoea. Based on a two-step interpretation beta-carotene is thus both a useful screening test for steatorrhoea (with a cut-off point of 100 micrograms/dl) and, more important, a valid, simple, and clinically practical alternative for fecal fat analysis (if values are less than 47 micrograms/dl).

Topics: beta Carotene; Carotenoids; Celiac Disease; Colitis, Ulcerative; Crohn Disease; Diagnosis, Differential; Fats; Feces; Humans; Pancreatitis; Spectrophotometry

In a prospective study, several parameters of small intestinal function have been assessed in 20 patients with chronic relapsing pancreatitis with and without steatorrhoea. By and large all routine parameters of small intestinal function were found to be normal. In particular, neither a previously reported high incidence of lactase deficiency, nor D-xylose malabsorption or vitamin B12 depletion was observed. However, there was a high incidence of abnormal 14C-cholylglycine breath tests (40%), suggesting the presence of mild bacterial overgrowth. Occasionally, this condition was associated with diarrhoea and steatorrhoea, thus indicating that steatorrhoea remaining after high-dosage pancreatin supplementation might sometimes be due to bacterial overgrowth.

Topics: Alcoholism; beta Carotene; Breath Tests; Carotenoids; Chronic Disease; Fats; Feces; Folic Acid; Glycocholic Acid; Humans; Intestinal Absorption; Intestine, Small; Pancreatitis; Prospective Studies; Recurrence; Vitamin B 12