Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2015; 21(30): 9189-9208
Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9189
Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis: An updated systematic review and meta-analysis
Maziar Gooshe, Amir Hossein Abdolghaffari, Shekoufeh Nikfar, Parvin Mahdaviani, Mohammad Abdollahi
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
Amir Hossein Abdolghaffari, Pharmacology and Applied Medicine, Department of Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj 31375369, Iran
Amir Hossein Abdolghaffari, International Campus, ICTUMS, Tehran University of Medical Sciences, Tehran 1417614411, Iran
Shekoufeh Nikfar, Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 1417614411, Iran
Parvin Mahdaviani, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 1417614411, Iran
Author contributions: Gooshe M and Abdolghaffari AH contributed equally to this paper; Gooshe M reviewed data and drafted the manuscript; Abdolghaffari AH prepared the bibliography, collected data and edited the manuscript; Nikfar S conducted the meta-analysis, reviewed the data and the manuscript; Mahdaviani P prepared the bibliography, collected data and prepared the tables; and Abdollahi M conceived the study and edited the manuscript.
Conflict-of-interest statement: The authors declared no conflict-of-interest.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mohammad Abdollahi, PhD, Professor, 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. mohammad@tums.ac.ir
Telephone: +98-21-64122319 Fax: +98-21-66959104
Received: March 12, 2015
Peer-review started: March 13, 2015
First decision: March 26, 2015
Revised: April 15, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 14, 2015
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.

Keywords: Acute pancreatitis, Chronic pancreatitis, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Antioxidants, Meta-analysis

Core tip: Antioxidant therapy reduces the length of hospital stay in acute pancreatitis patients. Although antioxidant therapy shows no significant effect on serum amylase after less than 8 h sampling, it significantly reduces serum amylase after 24 h sampling. Antioxidant therapy has no significant effect on serum C reactive protein (CRP) after 5-7 d sampling, but significantly reduces serum CRP after 10 d sampling. Evidence to support the efficacy of antioxidant therapy in the management of chronic pancreatitis and post-endoscopic retrograde cholangiopancreatography pancreatitis is limited. Further trials should be based on etiology-differentiated designs.