The Antioxidant Profiles of Patients With Recurrent Acute and Chronic Pancreatitis Gareth J. Morris-Stiff, F.R.C.S(Eng.), David J. Bowrey, F.R.C.S(Eng.), David Oleesky, M.R.CPath., Mark Davies, M.B.B.Ch., Geoffrey W. B. Clark, F.R.C.S(Ed.), and Malcolm C. A. Puntis, F.R.C.S(Eng.) Departments of Surgery and Medical Biochemistry, University Hospital of Wales, Heath Park, Cardiff, United Kingdom OBJECTIVE: It has been suggested that patients with chronic pancreatitis have antioxidant deficiencies. It is unclear whether these antioxidant deficiencies also occur in patients with recurrent acute pancreatitis and whether this condition represents an intermediate state between normality and chronic pancreatitis. The aim of this study was to determine the antioxidant profiles of patients with pancreatitis (recur- rent acute and chronic) and to compare their profiles with a control population. METHODS: The antioxidant profiles of patients with chronic pancreatitis (n = 27) and recurrent acute pancreatitis (n = 11) were determined and compared with the antioxidant profiles of control subjects (n = 19). The following param- eters were measured in blood: trace elements (selenium, copper, zinc), vitamins A and E, and carotenoids (-caro- tene, -carotene, xanthine, -cryptoxanthine, lycopene). RESULTS: Patients with chronic pancreatitis had signifi- cantly lower plasma concentrations of selenium, vitamin A, vitamin E, -carotene, xanthine, -cryptoxanthine, and ly- copene compared with both control subjects and patients with recurrent acute pancreatitis (p  0.05). There were no significant differences between the antioxidant profiles of patients with chronic pancreatitis due to alcohol excess and patients with idiopathic chronic pancreatitis, or between the antioxidant profiles of patients with recurrent acute pancre- atitis and control subjects. CONCLUSIONS: Patients with chronic pancreatitis had evi- dence of multiple antioxidant deficiencies. The antioxidant profiles of patients with recurrent acute pancreatitis did not differ from those of control subjects, discounting the hy- pothesis that recurrent acute pancreatitis represents an in- termediate state between normality and chronic pancreatitis. (Am J Gastroenterol 1999;94:2135–2140. © 1999 by Am. Coll. of Gastroenterology) INTRODUCTION Chronic pancreatitis is a condition characterized by abdom- inal pain, malabsorption, steatorrhoea, and, in the later stages, diabetes mellitus. Its clinical course is punctuated by repeated hospital admissions and often a long-term require- ment for opiate analgesia (1). In the Western world alcohol excess underlies the condition in more than 60% of patients (2). The acinar cell injury that occurs in chronic pancreatitis is considered to be the consequence of uncontrolled free rad- ical activity (3). Several centers have reported antioxidant deficiencies in patients with chronic pancreatitis (4 – 6). However, it is unclear whether these antioxidant deficien- cies occur in patients with recurrent acute pancreatitis. We hypothesized that recurrent (nongallstone) acute pancreatitis represented an intermediate state characterized by antioxi- dant levels between those of normal subjects and patients with chronic pancreatitis. The aim of this study was to determine the antioxidant profiles of patients with pancre- atitis (recurrent acute and chronic) and to compare their profiles with those of a control population. MATERIALS AND METHODS Antioxidant profiles were determined for a prospectively identified cohort of control subjects and patients with recur- rent acute pancreatitis or chronic pancreatitis managed by a hepatopancreaticobiliary surgeon during the period 1995– 1998. Ethical approval for the study was granted by Bro-Taf Local Research Ethics Committee with each patient and control subject providing informed consent for venipunc- ture. For each patient the following information was recorded: age, gender, etiology of pancreatitis, and details of diagnos- tic imaging procedures. Patients who had undergone pan- creatic surgery were excluded, to eliminate the possible effects of pancreatic surgery on antioxidant profiles. The study population comprised 11 patients (seven men, four women) with recurrent acute pancreatitis (median age, 49 yr; range, 37–54 yr), 27 patients (23 men, four women) with chronic pancreatitis (median age, 51 yr; range, 45– 68 yr), and 19 control subjects (12 men, seven women; median age, 61 yr; range, 36 –73 yr). There were no significant differences in the age or gender distributions of the three groups. The etiology of chronic pancreatitis was related to excess alcohol intake in 14 patients (52%) and idiopathic in the THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 94, No. 8, 1999 © 1999 by Am. Coll. of Gastroenterology ISSN 0002-9270/99/$20.00 Published by Elsevier Science Inc. PII S0002-9270(99)00367-6