To assess the efficacy of oral citrate administration in dissolving intraductal stones in chronic pancreatitis, a controlled clinical trial vs placebo was carried out on a group of selected patients with advanced chronic calcified pancreatitis. Twenty-two cases were assigned to placebo for 18 mo, and then to citrate for a further 18 mo (20 g/d) (Schedule A); another 22 cases were randomly assigned to citrate (40 g/d) for 18 mo and then followed but not treated for a further 18 mo (Schedule B). Prior to entry and at the end of each 18 mo interval, clinical and lab data were collected and evaluated, and pancreatic calcifications were assessed. Whereas when the patients were on placebo a trend towards an increase in the number of calcifications was observed, at the end of the citrate treatments, one in four to one in five patients showed some reduction in radiologic calcification (p<0.05). Citrate was reasonably tolerated, and no relevant side effects were observed during and after its administration. Even if with the higher dose of citrate an increased number of patients underwent clinical remission, no clear relationship was found between the treatment being investigated and the clinical course of the disease. This investigation shows that oral citrate is capable of favoring some reduction of stones in patients with chronic calcified pancreatitis.
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