Variations in the levels of oxidative stress and antioxidants during early acute pancreatitis.

AIM: Acute pancreatitis (AP) is fatal when severe and oxidative stress (OS) is postulated to play an important role in its pathophysiology and the development of complications. OS and antioxidant status therefore need to be profiled during early AP. METHODS: Patients presenting to the Gastroenterology wards with early AP i.e. within 72 hours of onset of pain were included in the study. Also samples from 50 healthy controls were obtained for comparison. OS was estimated by levels of blood superoxide dismutase (SOD) and lipid peroxidation (thiobarbituric acid reactive substances; TBARS) and antioxidant status (AOS) by the ferric reducing ability of plasma (FRAP) and vitamin C at days 1, 3, and 7 of admission. RESULTS: OS was significantly higher in cases as compared with controls (p<0.001) on all days and showed a gradual decrease from day 1 to 7 (p<0.05). TBARS showed a higher fall in mild AP and better clinical outcome (p<0.003). Regarding the AOS, FRAP was significantly lower in cases (p<0.001) and decreased significantly from day 1 to 3 (p=0.017). CONCLUSIONS: High OS was observed during early phase of AP and a gradually improving AOS was associated with a better clinical outcome in patients with AP.

Effect of antioxidant therapy on hospital stay and complications in patients with early acute pancreatitis: a randomised controlled trial.

BACKGROUND: Oxidative stress (OS) in acute pancreatitis (AP) has been pathologically linked with the systemic inflammatory response and antioxidant supplementation may have a clinical benefit. METHODS: In this prospective, randomised open label, controlled pilot study, patients admitted within 72 hours of onset of pain were randomised to receive either placebo (only standard medical treatment; SMT) or antioxidants (vitamin C 500 mg, N-acetyl cysteine 200 mg 8 hourly and antoxyl forte 1 capsule hourly with standard medical treatment; SMT + AO) daily, following informed consent. Patients with co-morbid illness and pregnancy were excluded. Primary efficacy measures were length of hospital stay and complications whilst secondary measures were biochemical markers of oxidative stress (thiobarbituric acid reactive substances [TBARS] and superoxide dismutase [SOD] and total antioxidant capacity [TAC] and vitamin C) at Days 1, 3 and 7. RESULTS: Of 53 patients, 30 patients were randomised to SMT and 23 patients to SMT + AO. The mean duration of hospital stay in the SMT group (10.3 +/- 7 days) was more compared to SMT + AOT (7.2 +/- 5 days), but was not statistically significant (p=0.07), complications were similar in the 2 groups. At Day 7, OS was significantly lower in the SMT + AO group when compared with the SMT group (TBARS, p=0.05; SOD, p=0.03) with a significant increase in FRAP and vitamin C (p=0.01). CONCLUSIONS: Antioxidant supplementation may decrease the length of hospital stay and complication rate in patients with AP, but a larger clinical trial is needed to support this hypothesis. Further, it decreased the OS and improved the antioxidant status in patients with AP.