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World J Gastroenterol. Nov 21, 2021; 27(43): 7423-7432
Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7423
Idiopathic chronic pancreatitis: Beyond antioxidants
Rajiv M Mehta, Stephen J Pandol, Prachi R Joshi
Rajiv M Mehta, Department of Gastroenterology, Surat Institute of Digestive Science (SIDS) Hospital and Research Centre, Surat 395002, Gujarat, India
Stephen J Pandol, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Prachi R Joshi, Department of Gastroenterology and Clinical Research, SIDS Hospital and Research Centre, Surat 395002, Gujarat, India
Author contributions: Mehta RM, Pandol SJ, and Joshi PR were equally involved in writing the manuscript;Pandol SJ provided final approval of the manuscript; All authors meet the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the results reported.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-accessarticle that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Rajiv M Mehta, DNB, MBBS, MD, Consultant Physician-Scientist, Department of Gastroenterology, Surat Institute of Digestive Science (SIDS) Hospital and Research Centre, Opp. Gandhi College, Majura Gate, Surat 395002, Gujarat, India.
Received: March 30, 2021
Peer-review started: March 30, 2021
First decision: June 26, 2021
Revised: July 5, 2021
Accepted: October 27, 2021
Article in press: October 27, 2021
Published online: November 21, 2021
Processing time: 234 Days and 4.6 Hours

Chronic pancreatitis (CP) is a complex disease associated with gene-gene or gene-environment interactions. The incidence of idiopathic CP has shown an increasing trend, withits phenotypeshaving changed considerably in the last two decades. The diseaseitself can be regulated before it reaches the stage of established CP; however, the etiopathogenesis underlying idiopathic CP remains to be established, making the condition difficult to cure. Unfortunately, there also remains a lack of consensus regarding the beneficial effects of antioxidant therapiesfor CP. It is known that antioxidant therapy does not reduce inflammatory and fibrotic cytokines, making it unlikely that they could modulate the disease process. Although antioxidants are safe, very few studies to date have reported the long-term beneficial effects in patients with CP. Thus, studies are being performed to identify drugs that can improve symptoms and alter the natural history of CP. Statins, with their numerous pleiotropic effects, may play a role in the treatment of CP, butin 2006, their use was found to be associated with the undesirable side effect of promoting pancreatitis. Latter studies showed favourable effects of statins in CP, highlighting the particular benefits of lipophilic statins, such as lovastatin and simvastatin, over the hydrophilic statins, such as rosuvastatin. Ultimately, studies to repurpose N-acetylcysteine as a CP therapy areyielding very promising results.

Keywords: Chronic pancreatitis, Simvastatin, Antioxidants, Quality of life, N-acetylcysteine, Acute pancreatitis

Core Tip: The clinical management of a majority of chronic diseases has seen a paradigm shift over the last two decades. To date, however, a well-defined standard of care has not been established for patients with chronic pancreatitis (CP). Lack of sufficient scientific evidence regarding the use of antioxidant supplementation, in particular, provides opportunities to repurpose drugs and study their efficacy and safety in clinical trials. Statins and N-acetylcysteine represent two of the most promising molecules for the treatment of CP, today.