Magnesium for Pancreatitis: Does It Work?

randomized-controlled-trial PMID: 23320650

Quick Summary: A study looked at whether giving magnesium through an IV could prevent pancreatitis (inflammation of the pancreas) after a specific medical procedure. The study found that magnesium didn't help.

What The Research Found

Researchers wanted to see if giving patients magnesium before and after a procedure called ERCP could prevent pancreatitis. ERCP is a procedure used to diagnose and treat problems in the bile ducts and pancreas. The study found that magnesium didn't significantly reduce the chances of getting pancreatitis after the procedure.

Study Details

Who was studied: 502 adults who needed an ERCP procedure.

How long: The study followed patients until they were discharged from the hospital (about 4 days).

What they took: Half the patients received magnesium sulfate through an IV before and after the ERCP. The other half received a placebo (a "dummy" treatment).

What This Means For You

This study specifically looked at using magnesium intravenously (through an IV) to prevent pancreatitis after an ERCP procedure. It found no benefit. This doesn't mean that magnesium supplements are useless for all digestive issues. It just means that this specific method of giving magnesium didn't work in this situation. If you are considering taking magnesium supplements, talk to your doctor.

Study Limitations

The study was stopped early, which might have affected the results.

Researchers didn't measure how much magnesium actually got into the pancreas.

The study only included adults undergoing a specific procedure, so the results might not apply to everyone.

The study only looked at short-term effects (up to hospital discharge).

Key Findings

The study found no statistically significant reduction in post-ERCP pancreatitis incidence or severity with intravenous magnesium sulphate compared to placebo. Clinical pancreatitis occurred in 11.9% of magnesium-treated patients vs. 15.1% of controls (p=0.33). Secondary outcomes—including hyperlipasemia (24.3% vs. 27.5%, p=0.41), pain scores, analgesic use, and hospital stay (median 4 days in both groups)—also showed no meaningful differences.

Study Design

This was a phase III, multicenter, double-blind, placebo-controlled RCT conducted in adults undergoing ERCP. A total of 502 patients were randomized to receive magnesium sulphate or placebo across 10 centers in the Netherlands and Belgium. The primary endpoint was clinical post-ERCP pancreatitis incidence, with secondary endpoints assessing biochemical markers (hyperlipasemia), pain levels, analgesic requirements, and hospitalization duration.

Dosage & Administration

Participants received 4930 mg magnesium sulphate (equivalent to 20 mmol magnesium) intravenously 60 minutes before ERCP and repeated 6 hours post-procedure. The placebo group underwent identical administration timing and volume without magnesium.

Results & Efficacy

Incidence of pancreatitis: 11.9% (30/252) in magnesium group vs. 15.1% (38/251) in placebo (RR 0.79, 95% CI 0.51–1.22, p=0.33).
Hyperlipasemia: 24.3% (61/251) vs. 27.5% (69/251) (RR 0.88, 95% CI 0.66–1.18, p=0.41).
Pain scores: No significant differences reported at 24 hours or discharge.
Hospital stay: Median 4 days for both groups (p=0.88).
Safety: No major adverse effects attributed to magnesium sulphate.

Limitations

Early termination: The trial was halted prematurely due to futility, potentially underpowering the analysis.
Lack of biomarker monitoring: Intrapancreatic calcium levels or magnesium bioavailability were not measured post-administration.
Homogeneous population: Participants were adults with specific ERCP indications; results may not generalize to other demographics or oral magnesium formulations.
Short follow-up: Outcomes assessed only up to discharge (median 4 days), limiting insight into long-term effects.

Clinical Relevance

This trial does not support intravenous magnesium sulphate as an effective prophylaxis for post-ERCP pancreatitis in adults. While magnesium’s theoretical role as a calcium antagonist remains biologically plausible, the lack of clinical benefit here suggests route, timing, or dosage factors may limit efficacy. The findings emphasize the need for alternative strategies to address this complication. For supplement users, these results specifically apply to IV administration in ERCP contexts and do not negate potential benefits of oral magnesium in other digestive or metabolic conditions. Future research could explore different formulations, dosing regimens, or patient subgroups with higher baseline risk.

Note: This analysis focuses exclusively on the referenced trial (ISRCTN46556454) and does not extrapolate to other magnesium preparations or indications.