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Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis: An updated systematic review and meta-analysis.

Abstract

AIM

To investigate the efficacy and adverse effects of antioxidant therapy in acute pancreatitis (AP), chronic pancreatitis (CP) and post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).

METHODS

PubMed, Scopus, Google Scholar, Cochrane library database, and Evidence-based medicine/clinical trials published before August 2014 were searched. Clinical and laboratory outcomes of randomized trials of antioxidant therapy in patients with AP, CP and PEP were included. The methodological quality of the trials was assessed by the Jadad score based on the description of randomization, blinding, and dropouts (withdrawals). The results of the studies were pooled and meta-analyzed to provide estimates of the efficacy of antioxidant therapy.

RESULTS

Thirty four trials out of 1069 potentially relevant studies with data for 4898 patients were eligible for inclusion. Antioxidant therapy significantly reduced the length of hospital stay in AP patients {mean difference -2.59 d (95%CI: -4.25-(-0.93)], P = 0.002}. Although, antioxidant therapy had no significant effect on serum C reactive protein (CRP) after 5-7 d in AP patients [mean difference -9.57 (95%CI: -40.61-21.48, P = 0.55], it significantly reduced serum CRP after 10 d {mean difference -45.16 [95%CI: -89.99-(-0.33)], P = 0.048}. In addition, antioxidant therapy had no significant effect on CP-induced pain [mean difference -2.13 (95%CI: -5.87-1.6), P = 0.26]. Antioxidant therapy had no significant effects on the incidence of all types of PEP [mean difference 1.05 (95%CI: 0.74-1.5), P = 0.78], severe PEP [mean difference 0.92 (95%CI: 0.43-1.97), P = 0.83], moderate PEP [mean difference 0.82 (95%CI: 0.54-1.23), P = 0.33], and mild PEP [mean difference 1.33 (95%CI: 0.99-1.78), P = 0.06]. Furthermore, while antioxidant therapy had no significant effect on serum amylase after less than 8 h sampling [mean difference -20.61 (95%CI: -143.61-102.39), P = 0.74], it significantly reduced serum amylase close to 24-h sampling {mean difference -16.13 [95%CI: -22.98-(-9.28)], P < 0.0001}.

CONCLUSION

While there is some evidence to support antioxidant therapy in AP, its effect on CP and PEP is still controversial.

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  • Authors+Show Affiliations

    ,

    Maziar Gooshe, Amir Hossein Abdolghaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, and Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    ,

    Maziar Gooshe, Amir Hossein Abdolghaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, and Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    ,

    Maziar Gooshe, Amir Hossein Abdolghaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, and Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    ,

    Maziar Gooshe, Amir Hossein Abdolghaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, and Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    Maziar Gooshe, Amir Hossein Abdolghaffari, Mohammad Abdollahi, Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, and Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran 1417614411, Iran.

    Source

    World journal of gastroenterology 21:30 2015 Aug 14 pg 9189-208

    MeSH

    Abdominal Pain
    Acute Disease
    Antioxidants
    Biomarkers
    C-Reactive Protein
    Cholangiopancreatography, Endoscopic Retrograde
    Humans
    Inflammation Mediators
    Length of Stay
    Pancreatitis
    Pancreatitis, Chronic
    Severity of Illness Index
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    26290647

    Citation

    Gooshe, Maziar, et al. "Antioxidant Therapy in Acute, Chronic and Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: an Updated Systematic Review and Meta-analysis." World Journal of Gastroenterology, vol. 21, no. 30, 2015, pp. 9189-208.
    Gooshe M, Abdolghaffari AH, Nikfar S, et al. Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis: An updated systematic review and meta-analysis. World J Gastroenterol. 2015;21(30):9189-208.
    Gooshe, M., Abdolghaffari, A. H., Nikfar, S., Mahdaviani, P., & Abdollahi, M. (2015). Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis: An updated systematic review and meta-analysis. World Journal of Gastroenterology, 21(30), pp. 9189-208. doi:10.3748/wjg.v21.i30.9189.
    Gooshe M, et al. Antioxidant Therapy in Acute, Chronic and Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: an Updated Systematic Review and Meta-analysis. World J Gastroenterol. 2015 Aug 14;21(30):9189-208. PubMed PMID: 26290647.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis: An updated systematic review and meta-analysis. AU - Gooshe,Maziar, AU - Abdolghaffari,Amir Hossein, AU - Nikfar,Shekoufeh, AU - Mahdaviani,Parvin, AU - Abdollahi,Mohammad, PY - 2015/03/12/received PY - 2015/04/15/revised PY - 2015/06/15/accepted PY - 2015/8/21/entrez PY - 2015/8/21/pubmed PY - 2016/10/7/medline KW - Acute pancreatitis KW - Antioxidants KW - Chronic pancreatitis KW - Meta-analysis KW - Post-endoscopic retrograde cholangiopancreatography pancreatitis SP - 9189 EP - 208 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 21 IS - 30 N2 - AIM: To investigate the efficacy and adverse effects of antioxidant therapy in acute pancreatitis (AP), chronic pancreatitis (CP) and post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). METHODS: PubMed, Scopus, Google Scholar, Cochrane library database, and Evidence-based medicine/clinical trials published before August 2014 were searched. Clinical and laboratory outcomes of randomized trials of antioxidant therapy in patients with AP, CP and PEP were included. The methodological quality of the trials was assessed by the Jadad score based on the description of randomization, blinding, and dropouts (withdrawals). The results of the studies were pooled and meta-analyzed to provide estimates of the efficacy of antioxidant therapy. RESULTS: Thirty four trials out of 1069 potentially relevant studies with data for 4898 patients were eligible for inclusion. Antioxidant therapy significantly reduced the length of hospital stay in AP patients {mean difference -2.59 d (95%CI: -4.25-(-0.93)], P = 0.002}. Although, antioxidant therapy had no significant effect on serum C reactive protein (CRP) after 5-7 d in AP patients [mean difference -9.57 (95%CI: -40.61-21.48, P = 0.55], it significantly reduced serum CRP after 10 d {mean difference -45.16 [95%CI: -89.99-(-0.33)], P = 0.048}. In addition, antioxidant therapy had no significant effect on CP-induced pain [mean difference -2.13 (95%CI: -5.87-1.6), P = 0.26]. Antioxidant therapy had no significant effects on the incidence of all types of PEP [mean difference 1.05 (95%CI: 0.74-1.5), P = 0.78], severe PEP [mean difference 0.92 (95%CI: 0.43-1.97), P = 0.83], moderate PEP [mean difference 0.82 (95%CI: 0.54-1.23), P = 0.33], and mild PEP [mean difference 1.33 (95%CI: 0.99-1.78), P = 0.06]. Furthermore, while antioxidant therapy had no significant effect on serum amylase after less than 8 h sampling [mean difference -20.61 (95%CI: -143.61-102.39), P = 0.74], it significantly reduced serum amylase close to 24-h sampling {mean difference -16.13 [95%CI: -22.98-(-9.28)], P < 0.0001}. CONCLUSION: While there is some evidence to support antioxidant therapy in AP, its effect on CP and PEP is still controversial. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/26290647/Antioxidant_therapy_in_acute_chronic_and_post_endoscopic_retrograde_cholangiopancreatography_pancreatitis:_An_updated_systematic_review_and_meta_analysis_ L2 - http://www.wjgnet.com/1007-9327/full/v21/i30/9189.htm DB - PRIME DP - Unbound Medicine ER -