Nutritional Status in Patients with Chronic Pancreatitis

Authors

  • Yuriy A. Kucheryavyy Department of Internal Diseases Propaedeutics and Gastroenterology, Moscow State University of Medicine and Dentistry Named After A.I. Evdokimov of the Ministry of Healthcare of the Russian Federation, Delegatskaya Street, 20/1, 127473 Moscow, Russia
  • Dmitry N. Andreev Department of Internal Diseases Propaedeutics and Gastroenterology, Moscow State University of Medicine and Dentistry Named After A.I. Evdokimov of the Ministry of Healthcare of the Russian Federation, Delegatskaya Street, 20/1, 127473 Moscow, Russia

DOI:

https://doi.org/10.6000/1929-5634.2014.03.03.3

Keywords:

Chronic pancreatitis, exocrine pancreatic insufficiency, maldigestion, malnutrition, nutritive status.

Abstract

Chronic pancreatitis (CP) is defined as a continuing inflammatory disease of the pancreas that is characterized by irreversible morphological changes often associated with pain and the loss of exocrine and/or endocrine function, which may be clinically relevant. Maldigestion (absolute deficiency of pancreatic enzyme secretion) is a typical complication of CP of any etiology with long anamnesis. Fat malabsorption is considered to be the malnutrition base in CP patients. The purpose of this article is to evaluate the role of nutritive status and nutritive deficiency in CP patients, evaluate diagnostic approaches, correct nutritive status deviation with reference to previous experience, and explore the present situation and possible future perspectives.

References

Clain JE, Pearson RK. Diagnosis of chronic pancreatitis: is a gold standard necessary? Surg Clin NorthAm 1999; 79: 829-845. http://dx.doi.org/10.1016/S0039-6109(05)70046-3

Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013; 144: 1252-1261. http://dx.doi.org/10.1053/j.gastro.2013.01.068

Maev IV, Kucheriawyĭ IuA. Modern approaches to diagnostics and treatment of chronic pancreatitis. Klin Med (Mosk) 2013; 91: 10-16.

Afghani E, Sinha A, Singh VK. An overview of the diagnosis and management of nutrition in chronic pancreatitis. Nutr Clin Pract 2014; 29: 295-311. http://dx.doi.org/10.1177/0884533614529996

Pezzilli R, Morselli Labate AM, Ceciliato R, et al. Quality of life in patients with chronic pancreatitis. Dig Liver Dis 2005; 37: 181-189. http://dx.doi.org/10.1016/j.dld.2004.10.007

Rasmussen HH, Irtun O, Olesen SS, Drewes AM, Holst M. Nutrition in chronic pancreatitis. World J Gastroenterol 2013; 19: 7267-7275. http://dx.doi.org/ 10.3748/wjg.v19.i42.7267

Gachago C, Draganov PV. Pain management in chronic pancreatitis. World J Gastroenterol 2008; 14: 3137-3148. http://dx.doi.org/10.3748/wjg.14.3137

Giger U, Stanga Z, DeLegge MH. Management of chronic pancreatitis. Nutr Clin Pract 2004; 19: 37-49. http://dx.doi.org/10.1177/011542650401900137

Sikkens EC, Cahen DL, van Eijck C, Kuipers EJ, Bruno MJ. Patients with exocrine insufficiency due to chronic pancreatitis are undertreated: a Dutch national survey. Pancreatology 2012; 12: 71-73. http://dx.doi.org/10.1016/j.pan.2011.12.010

Skipworth JR, Raptis DA, Wijesuriya S, et al. The use of nasojejunal nutrition in patients with chronic pancreatitis. JOP 2011; 12: 574-580.

Kalvaria I, Labadarios D, Shephard GS, Visser L, Marks IN. Biochemical vitamin E deficiency in chronic pancreatitis. Int J Pancreatol 1986; 1: 119-128.

Twersky Y, Bank S. Nutritional deficiencies in chronic pancreatitis. Gastroenterol Clin North Am 1989; 18: 543-565.

Bang UC, Benfield T, Bendtsen F, Hyldstrup L, Beck Jensen JE. The risk of fractures among patients with cirrhosis or chronic pancreatitis. Clin Gastroenterol Hepatol 2014; 12: 320-326. http://dx.doi.org/10.1016/j.cgh.2013.04.031

Sikkens EC, Cahen DL, Koch AD, et al. The prevalence of fat-soluble vitamin deficiencies and a decreased bone mass in patients with chronic pancreatitis. Pancreatology 2013; 13: 238-242. http://dx.doi.org/10.1016/j.pan.2013.02.008

Duggan SN, Smyth ND, O'Sullivan M, Feehan S, Ridgway PF, Conlon KC. The prevalence of malnutrition and fat-soluble vitamin deficiencies in chronic pancreatitis. Nutr Clin Pract 2014; 29: 348-354. http://dx.doi.org/10.1177/0884533614528361

Glasbrenner B, Malfertheiner P, Büchler M, Kuhn K, Ditschuneit H. Vitamin B12 and folic acid deficiency in chronic pancreatitis: a relevant disorder? Klin Wochenschr 1991; 69: 168-172. http://dx.doi.org/10.1007/BF01665861

Girish BN, Rajesh G, Vaidyanathan K, Balakrishnan V. Zinc status in chronic pancreatitis and its relationship with exocrine and endocrine insufficiency. JOP 2009; 10: 651-656.

Kucheriavyĭ IuA, Moskaleva AB, Sviridova AV, et al. Nutritional status as a risk factor of chronic pancreatitis complications and pancreatic insufficiency development. Eksp Klin Gastroenterol 2012; 7: 10-16.

Dujsikova H, Dite P, Tomandl J, Sevcikova A, Precechtelova M. Occurrence of metabolic osteopathy in patients with chronic pancreatitis. Pancreatology 2008; 8: 583-586. http://dx.doi.org/10.1159/000159845

Lindkvist B, Dominguez-Munoz JE, Luaces-Regueira M, Castineiras-Alvarino M, Nieto-Garcia L, Iglesias-Garcia J. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatology 2012; 12: 305-310. http://dx.doi.org/10.1016/j.pan.2012.04.006

Marotta F, Labadarios D, Frazer L, Girdwood A, Marks IN. Fat-soluble vitamin concentration in chronic alcohol-induced pancreatitis. Relationship with steatorrhea. Dig Dis Sci 1994; 39: 993-998. http://dx.doi.org/10.1007/BF02087550

Hartmann D, Felix K, Ehmann M, et al. Protein expression profiling reveals distinctive changes in serum proteins associated with chronic pancreatitis. Pancreas 2007; 35: 334-342. http://dx.doi.org/10.1097/mpa.0b013e3180cac723

Schnitzler CM, Mesquita JM, Shires RJ. Cortical and trabecular bone microarchitecture and turnover in alcohol-induced chronic pancreatitis: a histomorphometric study. Bone Miner Metab 2010; 28: 456-467. http://dx.doi.org/10.1007/s00774-009-0151-x

Sobral-Oliveira MB, Faintuch J, Guarita DR, Oliveira CP, Carrilho FJ. Nutritional profile of asymptomatic alcoholic patients. Arq Gastroenterol 2011; 48: 112-11. http://dx.doi.org/10.1590/S0004-28032011000200006

Haaber AB, Rosenfalck AM, Hansen B, Hilsted J, Larsen S. Bone mineral metabolism, bone mineral density, and body composition in patients with chronic pancreatitis and pancreatic exocrine insufficiency. Int J Pancreatol 2000; 27: 21-27. http://dx.doi.org/10.1385/IJGC:27:1:21

Morillas Ariño C, Hernández Mijares A, Morillas Ariño MJ, et al. Nutritional status assessment in diabetes mellitus secondary to chronic alcoholic pancreatitis. Med Clin (Barc) 1997; 108: 373-376.

Domínguez-Muñoz JE, Iglesias-García J, Vilariño-Insua M, Iglesias-Rey M. 13C-mixed triglyceride breath test to assess oral enzyme substitution therapy in patients with chronic pancreatitis. Clin Gastroenterol Hepatol 2007; 5: 484-488. http://dx.doi.org/10.1016/j.cgh.2007.01.004

Affronti J. Chronic pancreatitis and exocrine insufficiency. Prim Care 2011; 38: 515-537. http://dx.doi.org/10.1016/j.pop.2011.05.007

Armbrecht U. Chronic pancreatitis: weight loss and poor physical performance - experience from a specialized rehabilitation centre. Rehabilitation (Stuttg) 2001; 40: 332-336. http://dx.doi.org/10.1055/s-2001-18966

Riediger H, Adam U, Fischer E, et al. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007; 11: 949-959; discussion 959-960. http://dx.doi.org/10.1007/s11605-007-0155-6

Park JW, Jang JY, Kim EJ, et al. Effects of pancreatectomy on nutritional state, pancreatic function and quality of life. Br J Surg 2013; 100: 1064-1070. http://dx.doi.org/10.1002/bjs.9146

Ahmad SA, Edwards MJ, Sutton JM, et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg 2012; 256: 529-37. http://dx.doi.org/10.1097/SLA.0b013e318265ef0b

Petersen JM, Forsmark CE. Chronic pancreatitis and maldigestion. Semin Gastrointest Dis 2002; 13: 191-199.

Havala T, Shronts E, Cerra F. Nutritional support in acute pancreatitis. Gastroenterol Clin North Am 1989; 18: 525-542.

Di Carlo V, Nespoli A, Chiesa R, et al. Hemodynamic and metabolic impairment in acute pancreatitis. World J Surg 1981; 5: 329-339. http://dx.doi.org/10.1007/BF01657989

Shaw JH, Wolfe RR. Glucose, fatty acid, and urea kinetics in patients with severe pancreatitis. The response to substrate infusion and total parenteral nutrition. Ann Surg 1986; 204: 665-672. http://dx.doi.org/10.1097/00000658-198612000-00008

Hébuterne X, Hastier P, Péroux JL, Zeboudj N, Delmont JP, Rampal P. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig Dis Sci 1996; 41: 533-539. http://dx.doi.org/10.1007/BF02282334

Dickerson RN, Vehe KL, Mullen JL, Feurer ID. Resting energy expenditure in patients with pancreatitis. Crit Care Med 1991; 19: 484-490. http://dx.doi.org/10.1097/00003246-199104000-00005

Sitzmann JV, Steinborn PA, Zinner MJ, Cameron JL. Total parenteral nutrition and alternate energy substrates in treatment of severe acute pancreatitis. Surg Gynecol Obstet 1989; 168: 311-317.

Marulendra S, Kirby DF. Nutrition support in pancreatitis. Nutr Clin Pract 1995; 10: 45-53. http://dx.doi.org/10.1177/011542659501000245

Chowdhury RS, Forsmark CE, Davis RH, Toskes PP, Verne GN. Prevalence of gastroparesis in patients with small duct chronic pancreatitis. Pancreas 2003; 26: 235-238. http://dx.doi.org/10.1097/00006676-200304000-00005

Davies AR, Froomes PR, French CJ, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med 2002; 30: 586-90. http://dx.doi.org/10.1097/00003246-200203000-00016

DiMagno EP, Go VL, Summerskill WH. Relations between pancreatic enzyme ouputs and malabsorption in severe pancreatic insufficiency. N Engl J Med 1973; 288: 813-815. http://dx.doi.org/10.1056/NEJM197304192881603

Cuntz U, Frank G, Lehnert P, Fichter M. Interrelationships between the size of the pancreas and the weight of patients with eating disorders. Int J Eat Disord 2000; 27: 297-303. http://dx.doi.org/10.1002/(SICI)1098-108X(200004)27:3<297::AID-EAT6>3.0.CO;2-6

El-Hodhod MA, Nassar MF, Hetta OA, Gomaa SM. Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery. Eur J Clin Nutr 2005; 59: 467-473. http://dx.doi.org/10.1038/sj.ejcn.1602053

Sauniere JF, Sarles H. Exocrine pancreatic function and protein-calorie malnutrition in Dakar and Abidjan (West Africa): silent pancreatic insufficiency. Am J Clin Nutr 1988; 48: 1233-1238.

Swenne I, Borg LA, Crace CJ, Schnell Landström A. Persistent reduction of pancreatic beta-cell mass after a limited period of protein-energy malnutrition in the young rat. Diabetologia 1992; 35: 939-945. http://dx.doi.org/10.1007/BF00401422

Volk BW, Lazarus SS. Rabbit Pancreas in Protein Malnutrition (Experimental Kwashiorkor) and after Cortisone Administration. Am J Pathol 1960; 37: 121-135.

Lazarus SS, Volk BW. Electron microscopy and histochemistry of rabbit pancreas in protein malnutrition (Experimental kwashiorkor). Am J Pathol 1964; 44: 95-111.

Blackburn WR, Vinijchaikul K. The pancreas in kwashiorkor. An electron microscopic study. Lab Invest 1969; 20: 305-18.

Brooks SE, Golden MH. The exocrine pancreas in kwashiorkor and marasmus. Light and electron microscopy. West Indian Med J 1992; 41: 56-60.

Schnelldorfer T, Adams DB. The effect of malnutrition on morbidity after surgery for chronic pancreatitis. Am Surg 2005; 71: 466-472; discussion 472-473.

Duggan S, O’Sullivan M, Feehan S, Ridgway P, Conlon K. Nutrition treatment of deficiency and malnutrition in chronic pancreatitis: a review. Nutr Clin Pract 2010; 25: 362-370. http://dx.doi.org/10.1177/0884533610373772

Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part I: review of principles and methods. Clin Nutr 2004; 23: 1226-1243. http://dx.doi.org/10.1016/j.clnu.2004.06.004

Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 2004; 23: 1430-1453. http://dx.doi.org/10.1016/j.clnu.2004.09.012

Norman K, Pirlich M, Sorensen J, et al. Bioimpedance vector analysis as a measure of muscle function. Clin Nutr 2009; 28: 78-82. http://dx.doi.org/10.1016/j.clnu.2008.11.001

Tieland M, Dirks ML, van der Zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 2012; 13: 713-719. http://dx.doi.org/10.1016/j.jamda.2012.05.020

Candow DG, Forbes SC, Little JP, Cornish SM, Pinkoski C, Chilibeck PD. Effect of nutritional interventions and resistance exercise on aging muscle mass and strength. Biogerontology 2012; 13: 345-358. http://dx.doi.org/10.1007/s10522-012-9385-4

Geirsdottir OG, Arnarson A, Briem K, Ramel A, Jonsson PV, Thorsdottir I. Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders. J Gerontol A Biol Sci Med Sci 2012; 67: 1259-1265. http://dx.doi.org/10.1093/gerona/gls096

Norman K, Stobäus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 2011; 30: 135-142. http://dx.doi.org/10.1016/j.clnu.2010.09.010

Słodkowski M, Rubinsztajn R, Cebulski W, Krasnodebski IW. A case report of severe hypophosphatemia in the course of refeeding syndrome. Pol Merkur Lekarski 2004; 17: 638-639.

Harris JA, Benedict FG. A Biometric Study of Human Basal Metabolism. Proc Natl Acad Sci USA 1918; 4: 370-373. http://dx.doi.org/10.1073/pnas.4.12.370

Dhingra R, Singh N, Sachdev V, Upadhyay AD, Saraya A. Effect of antioxidant supplementation on surrogate markers of fibrosis in chronic pancreatitis: a randomized, placebo-controlled trial. Pancreas 2013; 42: 589-595. http://dx.doi.org/10.1097/MPA.0b013e31826dc2d7

White JV, Guenter P, Jensen G, Malone A, Schofield M; Academy of Nutrition and Dietetics Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Consensus statement of the academy of nutrition and Dietetics/American society for parenteral and enteral nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet 2012; 112: 730-738. http://dx.doi.org/10.1016/j.jand.2012.03.012

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22: 321-336. http://dx.doi.org/10.1016/S0261-5614(02)00214-5

Streppel MT, de Vries JH, Meijboom S, et al. Relative validity of the food frequency questionnaire used to assess dietary intake in the Leiden Longevity Study. Nutr J 2013; 12: 75. http://dx.doi.org/10.1186/1475-2891-12-75

Singh S, Midha S, Singh N, Joshi YK, Garg PK. Dietary counseling versus dietary supplements for malnutrition in chronic pancreatitis: a randomized controlled trial. Clin Gastroenterol Hepatol 2008; 6: 353-359. http://dx.doi.org/10.1016/j.cgh.2007.12.040

Yeh YY, Zee P. Relation of ketosis to metabolic changes induced by acute medium-chain triglyceride feeding in rats. J Nutr 1976; 106: 58-67.

Nakajima K, Oshida H, Muneyuki T, Kakei M. Pancrelipase: an evidence-based review of its use for treating pancreatic exocrine insufficiency. Core Evid 2012; 7: 77-91. http://dx.doi.org/10.2147/CE.S26705

Domínguez-Muñoz JE. Chronic pancreatitis and persistent steatorrhea: what is the correct dose of enzymes? Clin Gastroenterol Hepatol 2011; 9: 541-546. http://dx.doi.org/10.1016/j.cgh.2011.02.027

Domínguez-Muñoz JE, Iglesias-García J. Oral pancreatic enzyme substitution therapy in chronic pancreatitis: is clinical response an appropriate marker for evaluation of therapeutic efficacy? JOP 2010; 11: 158-162.

Plauth M, Cabré E, Campillo B, et al. ESPEN Guidelines on Parenteral Nutrition: hepatology. Clin Nutr 2009; 28: 436-444. http://dx.doi.org/10.1016/j.clnu.2009.04.019

Lochs H, Dejong C, Hammarqvist F, et al. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clin Nutr 2006; 25: 260-274. http://dx.doi.org/10.1016/j.clnu.2006.01.007

Meier RF, Beglinger C. Nutrition in pancreatic diseases. Best Pract Res Clin Gastroenterol 2006; 20: 507-529. http://dx.doi.org/10.1016/j.bpg.2006.01.004

Meier R, Ockenga J, Pertkiewicz M, et al. ESPEN Guidelines on Enteral Nutrition: Pancreas. Clin Nutr 2006; 25: 275-284. http://dx.doi.org/10.1016/j.clnu.2006.01.019

Gianotti L, Meier R, Lobo DN, et al. ESPEN guidelines on parenteral nutrition: pancreas. Clin Nutr. 2009; 28: 428-435. http://dx.doi.org/10.1016/j.clnu.2009.04.003

Stanga Z, Giger U, Marx A, DeLegge MH. Effect of jejunal long-term feeding in chronic pancreatitis. JPEN J Parenter Enteral Nutr 2005; 29: 12-20. http://dx.doi.org/10.1177/014860710502900112

Hamvas J, Schwab R, Pap A. Jejunal feeding in chronic pancreatitis with severe necrosis. JOP. J Pancreas (Online) 2001; 2: 112-116.

Toskes PP. Update on diagnosis and management of chronic pancreatitis. Curr Gastroenterol Rep 1999; 1: 145-153. http://dx.doi.org/10.1007/s11894-996-0014-8

Corcoy R, Sanchez JM, Domingo P, Net A. Nutrition in the patient with severe acute pancreatitis. Nutrition 1988; 4: 269-75.

Verlaan M, Roelofs HM, van-Schaik A, et al. Assessment of oxidative stress in chronic pancreatitis patients. World J Gastroenterol 2006; 12: 5705-5710.

Morris-Stiff GJ, Bowrey DJ, Oleesky D, Davies M, Clark GW, Puntis MC. The antioxidant profiles of patients with recurrent acute and chronic pancreatitis. Am J Gastroenterol 1999; 94: 2135-2140. http://dx.doi.org/10.1111/j.1572-0241.1999.01311.x

Valko M, Leibfritz D, Moncol J, Cronin MT, Mazur M, Telser J. Free radicals and antioxidants in normal physiological functions and human disease. Int J Biochem Cell Biol 2007; 39: 44-84. http://dx.doi.org/10.1016/j.biocel.2006.07.001

McCloy R. Chronic pancreatitis at Manchester, UK. Focus on antioxidant therapy. Digestion 1998; 59 Suppl 4: 36-48. http://dx.doi.org/10.1159/000051441

Braganza JM, Schofield D, Snehalatha C, Mohan V. Micronutrient antioxidant status in tropical compared with temperatezone chronic pancreatitis. Scand J Gastroenterol 1993; 28: 1098-1104. http://dx.doi.org/10.3109/00365529309098316

Szuster-Ciesielska A, Daniluk J, Kandefer-Szerszen M. Oxidative stress in blood of patients with alcohol-related pancreatitis. Pancreas 2001; 22: 261-266. http://dx.doi.org/10.1097/00006676-200104000-00006

Kodydkova J, Vavrova L, Stankova B, et al. Antioxidant status and oxidative stress markers in pancreatic cancer and chronic pancreatitis. Pancreas 2013; 42: 614-621. http://dx.doi.org/10.1097/MPA.0b013e318288360a

Grigsby B, Rodriguez-Rilo H, Khan K. Antioxidants and chronic pancreatitis: theory of oxidative stress and trials of antioxidant therapy. Dig Dis Sci 2012; 57: 835-841. http://dx.doi.org/10.1007/s10620-012-2037-3

Kirk GR, White JS, McKie L, et al. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. J Gastrointest Surg 2006; 10: 499-503. http://dx.doi.org/10.1016/j.gassur.2005.08.035

Uden S, Bilton D, Nathan L, Hunt LP, Main C, Braganza JM. Antioxidant therapy for recurrent pancreatitis: Placebocontrolled trial. Aliment Pharmacol Ther 1990; 4: 357-371. http://dx.doi.org/10.1111/j.1365-2036.1990.tb00482.x

Salim AS. Role of oxygen-derived free radical scavengers in the treatment of recurrent pain produced by chronic pancreatitis. A new approach. Arch Surg 1991; 126: 1109-1114. http://dx.doi.org/10.1001/archsurg.1991.01410330067010

Uden S, Schofield D, Miller PF, Day JP, Bottiglier T, Braganza JM. Antioxidant therapy for recurrent pancreatitis: Biochemical profiles in a placebo-controlled trial. Aliment Pharmacol Ther 1992; 6: 229-240. http://dx.doi.org/10.1111/j.1365-2036.1992.tb00266.x

Bilton D, Schofield D, Mei G, Kay PM, Bottiglieri T, Braganza JM. Placebo-controlled trials of antioxidant therapy including S-adenosulmethionine in patients with recurrent non-gallstone pancreatitis. Drug Invest 1994; 8: 10-20. http://dx.doi.org/10.1007/BF03257422

Banks PA, Hughes M, Ferrante M, Noordhoek EC, Ramagopal V, Slivka A. Does allopurinol reduce pain of chronic pancreatitis? Int J Pancreatol 1997; 22: 171-176.

Durgaprasad S, Pai CG, Vasanthkumar, Alvres JF, Namitha S. A pilot study of the antioxidant effect of curcumin in tropical pancreatitis. Indian J Med Res 2005; 122: 315-318.

Bhardwaj P, Garg PK, Maulik SK, Saraya A, Tandon RK, Acharya SK. A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis. Gastroenterology 2009; 136: 149-159.e2. http://dx.doi.org/10.1053/j.gastro.2008.09.028

Shah NS, Makin AJ, Sheen AJ, Siriwardena AK. Quality of life assessment in patients with chronic pancreatitis receiving antioxidant therapy. World J Gastroenterol 2010; 16: 4066-4071. http://dx.doi.org/10.3748/wjg.v16.i32.4066

Siriwardena AK, Mason JM, Sheen AJ, Makin AJ, Shah NS. Antioxidant therapy does not reduce pain in patients with chronic pancreatitis: the ANTICIPATE study. Gastroenterology 2012; 143: 655-663. http://dx.doi.org/10.1053/j.gastro.2012.05.046

Braganza JM. Micronutrient therapy for chronic pancreatitis: premises and pitfalls. JOP 2013; 14: 304-308. http://dx.doi.org/10.6092/1590-8577/1580

Talukdar R, Reddy DN. Pain in chronic pancreatitis: managing beyond the pancreatic duct. World J Gastroenterol 2013; 19: 6319-6328. http://dx.doi.org/10.3748/wjg.v19.i38.6319

Cai GH, Huang J, Zhao Y, Chen J, Wu HH, Dong YL, Smith HS, Li YQ, Wang W, Wu SX. Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis. Pain Physician 2013; 16: 521-532.

Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007; 297: 842-857. http://dx.doi.org/10.1001/jama.297.8.842

Downloads

Published

2014-10-03

How to Cite

Kucheryavyy, Y. A., & Andreev, D. N. (2014). Nutritional Status in Patients with Chronic Pancreatitis. Journal of Nutritional Therapeutics, 3(3), 122–132. https://doi.org/10.6000/1929-5634.2014.03.03.3

Issue

Section

Articles