Can we help patients with chronic pancreatitis to stop smoking?

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Abstracts / Pancreatology 14 (2014) S1eS129

was found in 27 (84.4%) patients of main group and 16 (53.3%) patients of comparison group. Conclusion: Enterosorbtion is an effective method of CP treatment in patients with food toxicoinfection.

T-090. Methionine containing antioxidants for pain in chronic pancreatitis: a systematic review and metaanalysis. Rupjyoti Talukdar a, H.V.V. Murthy b, D. Nageshwar Reddy a a Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India b Biostatistics, Asian Institute of Gastroenterology, Hyderabad, India

Background: Pain in CP results from recurrent inflammation and neuroimmune alterations. These mechanisms are associated with oxidative stress, marked by depletion antioxidant defenses including methionine. Methionine maintains the acinar cell transsulfuration pathway thereby protecting from them oxidative injury. Aims: We performed a systematic review and metaanalysis of trials evaluating the role of methionine containing antioxidants in CP. Patients & methods: Literature search was conducted in Medline/ Pubmed, EMBASE, and Cochrane databases. Systematic review and metaanalysis was performed according to PRISMA guidelines. Primary study outcome was pain relief. Quality assessment was performed using Jadad score. Heterogeneity was assessed by the Q and I2 measures; and publication bias by Egger’s test. Random effect model (DerSimonian and Laird) was used. Results: Five studies in English language involving 345 patients were identified that used methionine containing antioxidants. The study duration ranged from 10 weeks to 6 months. Four studies had a high quality. All five studies used methionine, organic selenium, ascorbate, beta-carotene and alpha-tocoferol. There was significant heterogeneity among studies (Tau2- 0.634; Q- 17.9 [p¼0.001] and I2- 88.8%). Three studies that reported a change in pain scores as an outcome were metaanalyzed. Overall effect [standardized difference in means (95% CI)] in pain score reduction by methionine containing antioxidants was -0.96 (-1.92 to -0.00)[z¼ -1.96; p¼0.05). The fourth study looked at number of painful days, which was significantly lower in patients taking antioxidants. Conclusion: Methionine containing antioxidants appear to result in significant pain reduction in CP. Further randomized controlled trials with homogeneous outcome measures are needed.

T-091. € m and in alDifferences in nicotine dependence according to fagerstro cohol-dependence typology according to lesch in patients with alcohol-related liver cirrhosis and alcohol-related chronic pancreatitis €ssner, Jonas Rosendahl Christian Zapf, Joachim Mo

Disorders) and ICD-10. All standardised interviews were conducted by the same person. Results: Our preliminary results (n¼6) of the pilot phase show no differences for all the investigated parameters in both groups. The pilot phase demonstrated the feasibility of the questionnaire. The investigation of further patients (n¼150 in each group) is ongoing. Conclusion: The aim of the study, which is to reveal whether there are differences in regard of the alcohol and nicotine dependence in patients with alcohol-related LC or CP, can not be answered sufficiently until now. Preliminary results displayed no differences in the distinct groups. However, if differences are observed, these might have implications for the treatment of the patients, for example in case of acute alcohol withdrawl symptoms.

T-092. Chronic pancreatitis: as often does meet its co-disease with gastroenterology pathology? N. Christich Bukovynian State Medical University, Ukraine Background: Comorbidity of chronic pancreatitis (CP) and gastroduodenal diseases and biliary systems stipulates ill-timed diagnostics, and «masks» a disease hides under that, negatively influence on adequacy of treatment. This is determining actuality of study of comorbidity of these diseases. Aims: The aim of work was an exposure of frequency of combination of CP with diseases gastro-duodenal and biliary systems. Materials & methods: 252 patients are inspected in age from 20 till 61 years (the middle age was equal 40,5), now and then - under age 20 years. Thus CP is diagnosed at 53 patients, chronic recrudescent pancreatitis (CRP) - at 199 patients. The estimation of research results was conducted on the basis of anamnesis data, data of analysis of ambulatory maps. Results: Combination of diseases was observed almost in 80,9% cases of primary appeal of patients. Alcoholic etiology and smoking are educed for 47,3% patients. An alcoholic pancreatitis men were ill in most cases, for the women of CP more often met at the dyskinesias of gall-bladder and bileexcreting system. For other patients (42,3%) secondary character of CP is diagnosed on a background the diseases of organs of digestion (at 18,2% an initial diagnosis was a peptic ulcer, at 29,2% chronic primary gastroduodenitis, at 42,6% is a chronic cholecystitis (from them calculary - at 10,1%)). Conclusion: The flow of CP often combines with gastroenterology diseases, that it is necessary to take into account, because they change a symptomatology and flow of disease, and also adequacy of medical tactics.

T-093. Can we help patients with chronic pancreatitis to stop smoking? Lisa Ballard a, Angel Castro Silva b, Mohammed Abu-Hilal c, Colin Johnson c, Fanny Shek c a

Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University Clinic Lei, Germany Background: Alcohol abuse is the most common risk factor for development of chronic pancreatitis (CP) and liver cirrhosis (LC). At least in CP smoking seems to be an additional risk factor. So far no epidemiological study evaluated the presence of the type and the strength of alcohol and nicotine dependence in both disease entities. Aims: Therefore, we aim to assess these parameters in patients with alcohol-related LC and alcohol-related CP to better understand why patients develop the one or the other disease entity or both. Patients & methods: To characterise the type of alcohol dependence we used the Lesch typology (Lesch Alcoholism Typology v.3.1.0; www.lat-online.at). Nicotine dependence was classified according to the € m questionnaire. Alcohol dependence and alcohol consumption Fagerstro were classified with DSM-IV (Diagnostic and Statistical Manual of Mental

Solent NHS Trust, United Kingdom The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, United Kingdom c University Hospital Southampton NHS Foundation Trust, United Kingdom b

Background: Studies have documented the association of chronic pancreatitis(CP)-related disease and tobacco smoking. Therefore, smoking cessation should be encouraged in these patients. NHS Stop Smoking Services, England(April 2012-March 2013) has shown that 52% of those setting a date to quit successfully quit in 4-weeks however this is reduced to 15% at one year. Aims: In this study, we aim to investigate whether we were able to help patients with Chronic Pancreatitis to stop smoking. Patients & methods: May-November 2013, patients were recruited from the Joint Pancreatitis Clinic in Southampton. A Smoking Cessation Advisor from Southamtpon Quitters invited patients to engage with the service and pending on their interests, a telephone contact was set up. Both

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Nicotine Replacement Therapy and Group Therapy were available. The demographics and characteristics of the patients were also collected. The smoking status were checked at week-4, -12 and -24. Results: 16 patients showed interests in engaging with the Quitters. The mean age was 50 (range 21-63). There were 7 male and 9 female. All but 1 of the patients have alcoholic CP(15), the other had recurrent acute pancreatitis(1). Most of the patients were cigarette smokers(5-30 cigarettes per day,14/16), with 1 pipe smoker and other rolled his own tobacco. At week-4, 4 patients(4/16) had stopped smoking and remained smoke-free at week-12. By week-24, 3 patients(3/16) remain smokefree and 1 was lost to follow-up. Conclusion: Although this was a small study, we demonstrated that some CP patients would engage with Southampton Quitters giving the opportunity however longer term follow-up would be needed.

T-094. Effect of tobacco compared with alcohol on pancreatic acinar cell death associated with pancreatitis: necrosis or apoptosis? ~ eira-Alvarin ~ o a, María Luaces-Regueira a, Margarita Castin ~ oz b J. Enrique Domínguez-Mun a

Foundation for Research in Digestive Diseases, Spain University Hospital of Santiago de Compostela, Foundation for Research in Digestive Diseases, Spain b

Background: Acinar cell death is part of the pathophysiological process of pancreatitis. Previous studies from our group have shown that tobacco is able to initiate the inflammatory process and to induce the production of reactive oxygen species (ROS) in pancreatic acinar cells. Aims: To study the role of tobacco compared with alcohol on cell death process, both necrosis and apoptosis, in pancreatic acinar cells. Materials & methods: Isolated acinar cells from mouse pancreas were exposed to different concentrations of tobacco (from 0.001 to 0.4mg/ml) or ethanol (from 10 to 100 mM). CCK 100mM was used as positive control. Cell necrosis was examined by fluorescence assay (propidium iodide) and by spectrophotometry (lactate dehydrogenase (LDH). Apoptosis was evaluated by western blot (caspase3 activation). Results are expressed as mean±SEM. Data were analyzed by ANOVA. Results: Tobacco at 0.3 and 0.4 mg/ml induced 14.3% and 19.4% acinar cell necrosis respectively (p <0.05 vs negative control (-3.3%)). LDH production was observed in response to high doses of tobacco (1.83 fold over the negative control at 0.3 mg/ml and 1.98 at 0.4 mg/ml). Tobacco 0.01 y 0.1mg/mL increased caspase 3 activation (2.5±0.36 and 2.17±0.39 fold over the negative control respectively) (p¼0.028). Alcohol did not induce cell necrosis nor apoptosis. Conclusion: Based on these results and on our previous findings, mild doses of tobacco initiate the inflammatory process and induce acinar cell death by apoptosis, while high doses of tobacco induce cell necrosis associated with ROS production. Therefore, tobacco is able to trigger the pathophysiological events associated with pancreatitis.

T-095. Distal intestinal obstruction syndrome in adult patients with cystic fibrosis mimicking ileocolonic crohn?s disease. Denisse Sihuay Diburga a, Andrea Montenegro a, Xavier Merino b, Xavier Molero a a Exocrine Pancreatic Diseases Research Group, Hospital Universitari Vall d?Hebron, Barcelona, Spain, Peru b Department of Radiology. Hospital Universitari Vall d?Hebron, Barcelona, Spain, Spain

Background: Cystic Fibrosis (CF) has been associated with autoinflammatory disorders including Crohn’s Disease (CD). However, in patients with CF, diagnosis of CD is challenging because ileal stenosis could be consequence of distal intestinal obstruction syndrome (DIOS). Aims: To describe the clinical and histopathologic features of an adult patient with CF and DIOS previously diagnosed and treated for CD, and to

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review the clinical records of 5 additional patients diagnosed between 2012 and 2013. Patients & methods: Case reports from a CF reference medical centre. Results: Index patient was a 25eyeareold man with CF (F508del/ F508del) and pancreatic insufficiency. He presented with intestinal subocclusion due to ileal stricture. Colonoscopy found ileal stenosis, diffuse hyperaemic mucosa and small ulcers. Biopsies were consistent with CD and the patient received steroids and azathioprine. Two years later he presented with intestinal obstruction requiring ileocolonic resection. Histology was consistent with DIOS. We diagnosed 6 patients (3 males) with DIOS out of 170 adult CF patients (3.5%). Mean age was 29 (22-38). Four patients had severe CFTR mutations. Five patients had pancreatic exocrine insufficiency, two a history of meconium ileus, but none endocrine insufficiency. Diagnosis was suspected after intestinal obstruction in 4 patients (2 required ileocolonic resection), abdominal pain or discomfort with ileal wall thickening and faecal retention. Non-operated patients were treated with oral polyethyleneglycol and intestinal lavages. Prophylactive polyethyleneglycol successfully prevented further intestinal obstructions. Conclusion: Diagnosis of DIOS should be considered in adult patients with CF presenting with abdominal pain and be differentiate it from Crohn's Disease.

T-096. Micronutrient antioxidant therapy has no effect on acquisition of insulin dependency in chronic pancreatitis Namal Rupasinghe, Santhalingam Jegatheeswaran, Ajith K. Siriwardena HPB Unit, Manchester Royal Infirmary, United Kingdom Background: Micronutrient antioxidant therapy has been demonstrated to be ineffective for pain relief in chronic pancreatitis (CP). However, as the ANTICIPATE study had intervention for 6 months only, is it possible that longer-term antioxidant therapy could modify the natural history of CP by modulation of acinar injury? Aims: To assess acquisition of insulin dependency in CP. Patients & methods: Case notes of patients with CP having their first in-patient 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 were treated with micronutrient methionine, selenium, vitamin C-based antioxidant therapy. Duration of disease prior to treatment, smoking history, disease categorisation at presentation using the Cambridge criteria, Steatorrhoea, diabetes mellitus and requirement for surgery or endoscopic intervention were assessed. Results: Median (range) age at diagnosis was 40 (14-66) years with median duration of disease at diagnosis being 2 (0 - 18) years. Distribution of CP category by Cambridge score was 1¼16, 2¼3, 3¼0, 4 ¼ 6 and 5¼ 5. 2 were diabetic at presentation and 1 on insulin. After a median follow-up of 3.5 (1-10) years, 7 (23%) were on insulin (P¼ 0.024 Fishers exact). 3 had undergone endoscopic intervention and 4 had undergone surgery for CP. Conclusion: This is a small cohort study but our results suggest that long-term use of micronutrient antioxidant does not prevent insulin dependency in CP.

T-097. Vitamin D in patients with chronic benign and malignant pancreatic diseases: A pilot study Raffaele Pezzilli a, Alessandra Barassi b, Gianvico Melzi d'Eril b a bPancreas Unit, Department of Digestive Diseases and Internal Medicine Sant Orsola-Malpighi Hospital, Italy b aCentral Laboratory, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy