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Efficacy and Predictors of Pain Response to Combined Antioxidants in Children with Chronic Pancreatitis

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Abstract

Background

Pain is a major problem in 90% of patients with chronic pancreatitis (CP). Studies evaluating response to antioxidants (AO) are conflicting and no pediatric studies are available.

Aims

To evaluate markers of oxidative stress (OS), and efficacy and predictors of response to AO in improving pain in children with CP.

Methods

Antioxidants were given to CP children for 6 months. Subjects were assessed at baseline and post-therapy for pain and markers of OS [serum thiobarbituric acid reactive substances (TBARS), superoxide dismutase (S-SOD)] and antioxidant levels [vitamin C, selenium, total antioxidant capacity-ferric reducing ability of plasma (FRAP)]. Matched healthy controls were assessed for OS and antioxidant levels. Good response was defined as ≥ 50% reduction in number of painful days/month.

Results

48 CP children (25 boys, age 13 years) and 14 controls were enrolled. 38/48 cases completed 6 months of therapy. CP cases had higher OS [TBARS (7.8 vs 5.2 nmol/mL; p < 0.001)] and lower antioxidant levels [FRAP (231 vs. 381.3 µmol/L; p = 0.003), vitamin C (0.646 vs. 0.780 mg/dL; p < 0.001)] than controls. Significant reduction in TBARS and S-SOD and increase in FRAP, vitamin C, and selenium occurred after 6 months. 10.5% cases had minor side effects. 26(68%) cases had a good response, with 9(24%) becoming pain-free. Subjects with severe ductal changes had lower median BMI (− 0.73 vs 0.10; p = 0.04) and responded less often than those with mild changes (17/29 vs 9/9; p = 0.036).

Conclusion

CP children have higher OS than healthy controls. Antioxidant therapy is safe. Pain response is seen in 68% cases, less often in patients with severe ductal changes.

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Abbreviations

CP:

Chronic pancreatitis

OS:

Oxidative stress

AO:

Antioxidants

MRCP:

Magnetic resonance cholangiopancreatography

MPD:

Main pancreatic duct

TBARS:

Thiobarbituric acid reactive substances

FRAP:

Ferric reducing ability of plasma

S-SOD:

Serum superoxide dismutase

Se:

Selenium

R+ :

Patients with ≥ 50% response in pain after antioxidant therapy

R− :

Patients with < 50% response, no change or worsening of pain after antioxidant therapy

BMI:

Body Mass Index

hpf:

High power field

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India

    Amrit Gopan, Anshu Srivastava, Amrita Mathias, Surender Kumar Yachha, Moinak Sen Sarma & Ujjal Poddar

  2. Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

    Sunil Kumar Jain

  3. Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

    Prabhakar Mishra

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Contributions

AG: Collection of data, analysis, and interpretation of data and drafting the article. AS: Conception and design of study, analysis of data, and co-drafting the manuscript. AM: Conducting the tests, collection of data, and revising the manuscript. SKY: Concept of study, interpretation of data, and revising it critically for important intellectual content. SKJ: Conducting the tests, data analysis, and revising it critically for important intellectual content. PM: Analysis and interpretation of data, revising it critically for important intellectual content. MSS: Interpretation of data and revising it for important intellectual content. UP: Interpretation of data and revising it for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Anshu Srivastava.

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Gopan, A., Srivastava, A., Mathias, A. et al. Efficacy and Predictors of Pain Response to Combined Antioxidants in Children with Chronic Pancreatitis. Dig Dis Sci 68, 1500–1510 (2023). https://doi.org/10.1007/s10620-022-07676-5

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