title: Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis.
abstract: OBJECTIVE
  Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach.
  
  
  METHODS
  All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure.
  
  
  RESULTS
  A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P < 0.001). Of the 288 patients, 261, 218, 112, and 51 patients were followed up for 3, 5, 10, and 15 years, respectively; 54.0%, 57.3%, 60.7%, and 68.8% of them became pain free at those follow-up periods.
  
  
  CONCLUSIONS
  Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.lastname: Shalimar
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shallu
authors.initials: S
authors.lastname: Midha
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Hasan
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajan
authors.initials: R
authors.lastname: Dhingra
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Garg
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage*; D004032:Diet; D013505:Digestive System Surgical Procedures; D016145:Endoscopy, Digestive System; D004798:Enzymes / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D050500:Pancreatitis, Chronic / Q000150:complications* / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000975:Antioxidants; D004798:Enzymes
keywords: abdominal pain; antioxidants; chronic pancreatitis; medical therapy