Efficacy of antioxidant therapy in improving painful chronic pancreatitis: A systematic review

Abstract

Background and aim: Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis with typical histological features, fully responding to steroids. Pancreatic exocrine function can be studied by dosage of fecal elastase 1 (FE1). Aim of this study was to evaluate pancreatic exocrine and endocrine function in patients suffering from AIP before and after steroid therapy, and in the follow-up. Material and methods: FE1 was evaluated both before and after steroid therapy and in the follow-up (1, 2 and 3 years) in 37 patients (24 males, 13 females, mean age at onset of the disease 45.7±15.5 years) diagnosed as having AIP between 2008 and 2012. Results: FE1 was 144.6±166.6 μg/g stool at clinical onset. 20 patients (54%) showed severe pancreatic exocrine insufficiency ( 200 μg/g stool). Before steroids, diabetes was diagnosed in 6 patients (16%) with low levels of FE1 (66.4±107.3 μg/g stool). Following steroids, FE1 increased in all patients (232.1±193.9 μg/g stool) (p<0.0001). However 40% of patients still showed severe pancreatic exocrine insufficiency after steroids. Predictive factors of low levels of FE1 are advanced age, weight loss, jaundice and steatorrhea. In short follow-up exocrine and endocrine pancreatic function remained stable. Conclusions: Patients suffering AIP show exocrine pancreatic insufficiency at clinical onset that improves after steroid therapy and remains stable during a 3-years follow-up.