Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7423
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.
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.