Does antioxidant therapy influence every aspect of quality of life?

Abstract

To present problems that might severely impact the conclusions drawn by the authors of an article on antioxidant treatment in chronic pancreatitis (World J Gastroenterol 2010; 16: 4066-4071). We analyzed and discussed this paper by Shah et al, and found that promising as it is, this study has some methodological shortcomings, such as: cross-sectional nature of the study, lack of initial evaluations of quality of life and regular follow-ups to determine the dynamics and real directions of changes in quality of life. We therefore concluded that the results of the study by Shah et al are biased and, although very promising, should not be considered as scientifically relevant.

Key Words: Chronic pancreatitis, Quality of life, Methodology, Antioxidants

TO THE EDITOR

We have read with great interest an article by Shah et al[1] (World J Gastroenterol 2010; 16: 4066-4071). Exciting news about the clinical use of antioxidant therapy seem to open an entirely new chapter in treatment of chronic pancreatitis. We have already published information on possibilities concerning the role of oxygen free radicals in experimental acute pancreatitis as well as the potential role of antioxidants in treatment the disease[2]. As a team of scientists and clinicians intensively involved in the treatment of pancreatic chronic pain, we have found the study presented by Shah et al[1] very promising.

Unfortunately, despite very good rationale and biochemical background, the manuscript cannot be considered as free of significant bias, that most probably severely impacts the final conclusions. The pain and quality of life (QoL) scores were obtained only after a 6-mo period of follow-up, there was no initial score at the beginning of the therapy. Moreover, the authors presented only measurement of pain and QoL, which does not seem to be sufficient in context of complexity of interactions (such as social and emotional) that chronic pancreatitis patients may experience[3,4]. In that circumstances, we would recommend that follow-up measurements should be made every month, as presented in other studies on pain in chronic pancreatitis and/or pancreatic cancer[3,4]. Lack of initial information, randomization and pain and QoL dynamics assessment leaves a suspicion that the patients treated with antioxidants suffered from less pain, had better QoL and consumed less opioids from the very beginning of this doubtlessly non-prospective, uncontrolled trial. Significant differences in almost every variable of QLQ-C30 seem to confirm our point of view. It is difficult to explain in any psychological paradigm or biochemical formulae, what possible influence could antioxidant therapy exert on cognitive or emotional functioning or, most interestingly on body image, alcohol-related guilt or even financial problems.

To sum up, we believe that antioxidants may offer a very interesting and promising supplementation to the treatment of chronic pancreatitis, but unfortunately, methodological problems presented in the article of Shah et al[1] completely disqualify the conclusions of the authors. We would be most happy to see a randomized prospective trial with dynamic evaluations that would confirm the results presented in this article.