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Methionine containing antioxidants for pain in chronic pancreatitis: a systematic review and metaanalysis.
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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
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