title: Does gabexate mesilate affect serum concentrations of acute phase proteins after endoscopic retrograde cholangiopancreatography examination?
abstract: OBJECTIVE
  To explore the possibility that the preventive effect of gabexate mesilate on endoscopic retrograde cholangiopancreatography-related acute pancreatitis may be mediated by its modulation of acute phase proteins.
  
  
  METHODS
  Thirty consecutive patients who underwent endoscopic retrograde cholangiopancreatography were randomly assigned to receive 1g of gabexate mesilate (13 patients) or a placebo (17 patients) by continuous i.v. infusion starting 30 minutes before the endoscopy session and continuing for 12 hours afterward. In all patients, C-reactive protein, serum amyloid A and interleukin 6 serum concentrations were determined before endoscopy and 4, 8, 12 and 24 hours afterward.
  
  
  RESULTS
  Interleukin 6 basal serum concentrations were not statistically different between patients who had been treated with gabexate mesilate and those who had received the placebo (P = 0.279), whereas C-reactive protein (P = 0.033) and serum amyloid A (P = 0.022) basal values were significantly lower in the gabexate mesilate group than in the placebo group. Compared to basal values, serum interleukin 6 concentrations significantly increased at 4 (P = 0.048) and at 8 (P = 0.025) hours; the increase of serum interleukin 6 concentrations was not significant at 12 (P = 0.092), but became significant at 24 (P = 0.025) hours. C-reactive protein and serum amyloid A serum concentrations increased significantly only at 12 (P = 0.001, P = 0.012, respectively) and 24 (P < 0.001, P = 0.013, respectively) hours. The modifications of serum concentrations of interleukin 6, C-reactive protein and serum amyloid A were not significantly different between the gabexate mesilate and the placebo groups.
  
  
  CONCLUSIONS
  Gabexate mesilate does not affect serum concentrations of acute phase proteins after endoscopic retrograde cholangiopancreatography examination and it is able to prevent acute pancreatitis related to endoscopic retrograde cholangiopancreatography via a different mechanism than that explored in this study.
authors.affiliation: Department of Internal Medicine, Azienda Ospedaliera Policlinico S. Orsola-Malpighi, Bologna, Italy. pezzilli@orsola-malpighi.med.unibo.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Armando
authors.initials: A
authors.lastname: Gabbrielli
authors.forename: Antonio Maria Morselli
authors.initials: AM
authors.lastname: Labate
authors.forename: Pasquale
authors.initials: P
authors.lastname: D'Alessio
authors.forename: Bahjat
authors.initials: B
authors.lastname: Barakat
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Francesco
authors.initials: F
authors.lastname: Dibenedetti
authors.forename: Margherita
authors.initials: M
authors.lastname: Massa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Merlini
authors.forename: Gianvico Melzi
authors.initials: GM
authors.lastname: d'Eril
mesh_terms: D000208:Acute Disease; D000209:Acute-Phase Proteins / Q000378:metabolism*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D005260:Female; D016670:Gabexate / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000517:prevention & control*; D011292:Premedication; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000685:Serum Amyloid A Protein / Q000378:metabolism
chemical_list: D000209:Acute-Phase Proteins; D015850:Interleukin-6; D015842:Serine Proteinase Inhibitors; D000685:Serum Amyloid A Protein; D016670:Gabexate; D002097:C-Reactive Protein