cholecystokinin and Calcinosis

This is a report on five patients who had acute attacks of pancreatitis (three cases complicated by pseudocysts). They all showed pancreatic calcifications on plain abdominal X-ray (n = 5), computed tomography (n = 3), or at postmortem examination (n = 1). Despite calcifications, the exocrine pancreatic function, as tested with the secretin-pancreozymin test and fecal fat analysis, was either normal or returned to normal. The conclusion is that pancreatic calcifications do not indicate severe exocrine pancreatic insufficiency and the necessity for pancreatic enzyme substitution. Calcifications are not necessarily a sign of chronic pancreatitis. They may result rather from scars following acute pancreatitis.

Topics: Acute Disease; Adult; Amylases; Calcinosis; Cholecystokinin; Feces; Female; Humans; Lipids; Male; Middle Aged; Pancreas; Pancreatitis; Reference Values; Secretin; Tomography, X-Ray Computed

Course and prognosis of 125 patients with chronic pancreatitis (CP) were evaluated. Follow-up period ranged from 1-20 years with a median of 6.3 years. The following conclusions were obtained. Recent increase of CP in our clinics was ascribed to alcoholic CP and idiopathic CP in the aged. Of 106 patients with pain, 74 showed improvement or disappearance of pain. Drinking habit and observation period were the main factors determining the rate of pain relief. Serial endoscopic retrograde pancreatography (ERP) showed aggravation in 17/47 patients, cholecystokinin-pancreozymin (CCK-PZ) secretin test in 4/40 patients, and oral glucose tolerance test (OGTT) in 7/25 patients. Exocrine function showed improvement in five patients, whereas endocrine function showed none. Improvement or aggravation of exocrine function was closely related to drinking habit. Main complications included 15 cases of peptic ulcer, 19 of pancreatic pseudocyst, and 15 of bile duct stenosis. Twenty-six patients died, often due to malignant neoplasms and diabetic complications. Those who continued drinking as much showed a lower survival rate than those who discontinued or decreased alcohol intake. The socioeconomic status deteriorated often due to pain or alcoholism. Three patients had to degrade jobs and six fell into inactive social life.

Topics: Age Factors; Alcoholism; Calcinosis; Cholecystokinin; Chronic Disease; Female; Glucose Tolerance Test; Humans; Longitudinal Studies; Male; Pain; Pancreatitis; Peptic Ulcer; Prognosis; Quality of Life; Sex Factors

The oral (PABA) pancreatic function test (PFT), the secretin-pancreozymin test and endoscopic retrograde pancreatography (ERCP) have been carried out in 32 patients with suspected chronic alcohol induced pancreatitis (CAIP) in order to evaluate which, if any, test was most likely to confirm the provisional diagnosis. Thirty one patients had changes of minimal (n = 6) moderate (n = 7) or advanced (n = 18) chronic pancreatitis on pancreatography, whilst one patient had a pancreas divisum. Eight hour urinary PABA excretion was significantly reduced in patients with moderate and advanced structural changes (p less than 0.001) and correlated significantly with all parameters of the PFT, although eight patients with an abnormal pancreatogram and pancreatic function test had a normal PABA value. The PFT was abnormal in 23 patients, but normal in five patients with an abnormal pancreatogram and low PABA value. Most patients with minimal change pancreatitis had a normal PABA test and PFT. We conclude that pancreatography appears to be the most sensitive method for detecting chronic pancreatic damage and for confirming a clinical diagnosis of chronic alcohol induced pancreatitis. Both the PFT and PABA test are useful confirmatory tests and whilst the PFT is slightly more sensitive for assessing pancreatic exocrine function, the PABA test is well tolerated and simple to perform. It may therefore be the complementary investigation of choice for this group of patients.

Topics: 4-Aminobenzoic Acid; Adult; Alcoholism; Calcinosis; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Secretin

The general profile of pain in the evolution of pancreatitis was analysed in relation to exocrine and endocrine pancreatic function in 127 patients with primary chronic pancreatitis followed up over 3 years. Pain decreased or disappeared in 67.8% and 55.9% of calcifying pancreatitis, respectively. While pancreatic exocrine function remained abnormal in spite of an improvement of pain in 72% of 18 patients with calcifying pancreatitis, it improved with the amelioration of pain in 64% of 25 patients with non-calcifying pancreatitis during the follow-up period. Alcohol abstinence seems most important for pain relief in patients with non-calcifying pancreatitis but not calcifying pancreatitis. Changes in glucose tolerance test were not related with those in pain. In calcifying pancreatitis, 69.2% of patients with calcifying pancreatitis were diabetic or became so, while 66.7% of patients with non-calcifying pancreatitis remained non-diabetic during the observation period.

Topics: Adult; Alcohol Drinking; Calcinosis; Cholecystokinin; Chronic Disease; Dietary Fats; Female; Follow-Up Studies; Glucose Tolerance Test; Humans; Male; Middle Aged; Pain; Pancreatitis

Hexosamine concentration in human pure pancreatic juice was determined during wash-out phase and secretin stimulation phase. Specimens were collected by endoscopic retrograde catheterization of the papilla at one minute intervals for 20 minutes after intravenous injection of secretin (Eisai, 1 U/kg) and for 10 minutes after pancreozymin injection (Boots, 1 U/kg). In suspected and established chronic pancreatitis (calcifying or non-calcifying), hexosamine concentration was significantly raised during both wash-out phase and secretin phase. Hexosamine output was significantly raised in suspected chronic pancreatitis and non-calcifying chronic pancreatitis during both wash-out phase and secretin phase; in calcifying chronic pancreatitis, no significant increase in hexosamine output was noted during both phases because of decreased secretory volume. Significance of these findings was discussed in relation to the pathogenesis of chronic pancreatitis.

Topics: Alcoholism; Calcinosis; Cholecystokinin; Chronic Disease; Hexosamines; Humans; Pancreatic Juice; Pancreatitis; Secretin

Functional tests and ERP were performed in patients with chronic and acute pancreatitis and papillary stenosis; both diseases differ considerably as can be shown by both, pancreatography and degree of functional impairment. The different classification types of pancreatitis are based upon the Marseille Symposium. The ERP is the only x-ray procedure which allows the diagnosis of intrapapillar pancreatic duct stenosis. The ERP significantly improves diagnosis of the early stages of papillary stenosis of the pancreas. Neither secretin-pancreozymin test nor ERP are indicated in cases of primary chronic calcifying pancreatitis; in chronic relapsing calcifying pancreatitis they should be used for preoperative diagnostic purposes.

Topics: Adult; Aged; Calcinosis; Cholecystokinin; Chronic Disease; Diagnosis, Differential; Endoscopy; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis; Recurrence; Secretin

Topics: Adult; Aged; Alcoholism; Calcinosis; Celiac Disease; Cholecystokinin; Chronic Disease; Creatinine; Diabetes Complications; Feces; Female; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatitis; Secretory Rate; Stimulation, Chemical; Time Factors; Trypsin

Topics: Amylases; Calcinosis; Cholecystokinin; Clinical Enzyme Tests; Humans; Lipase; Lipomatosis; Necrosis; Pancreas; Pancreatic Diseases; Pancreatitis; Sclerosis; Secretin

Topics: Acute Disease; Adolescent; Adult; Aged; Alcoholism; Calcinosis; Celiac Disease; Child; Cholecystokinin; Chronic Disease; Diabetes Complications; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Recurrence; Secretin; Switzerland; Time Factors

Topics: Adolescent; Adult; Age Factors; Aged; Alcoholism; Calcinosis; Cholecystokinin; Chronic Disease; Dietary Carbohydrates; Dietary Fats; Dietary Proteins; Female; Glucose Tolerance Test; Humans; Japan; Male; Middle Aged; Occupations; Pancreas; Pancreatic Neoplasms; Pancreatitis; Secretin; Sex Factors; Smoking

Topics: Alcoholism; Amylases; Bicarbonates; Blood Group Antigens; Calcinosis; Cholecystokinin; Chronic Disease; Coronary Disease; Diabetes Mellitus; Dietary Proteins; Ethnicity; Female; Glucose; Humans; Intestinal Absorption; Male; Pancreas; Pancreatic Cyst; Pancreatic Juice; Pancreatitis; Secretin; South Africa; Sucrose

Topics: ABO Blood-Group System; Adult; Alcohol Drinking; Blood Protein Disorders; Calcinosis; Celiac Disease; Cholecystokinin; Chronic Disease; Female; Glucose Tolerance Test; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Radiography; Secretin; Sodium; Sweat

Topics: Adult; Calcinosis; Calcium; Cholecystokinin; Cholesterol; Chronic Disease; Glucose Tolerance Test; Humans; Insulin; Iodine Radioisotopes; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatitis; Phosphorus; Triolein

Topics: Adolescent; Adult; Amylases; Bicarbonates; Calcinosis; Cholecystokinin; Chronic Disease; Female; Humans; India; Intubation, Gastrointestinal; Lipase; Male; Pancreas; Pancreatic Juice; Pancreatitis; Peptide Hydrolases; Secretin; Secretory Rate

Topics: Calcinosis; Cholecystitis; Cholecystokinin; Cholelithiasis; Cholesterol; Female; Gallbladder; Gallbladder Diseases; Humans; Male

Topics: Adult; Amylases; Bicarbonates; Calcinosis; Celiac Disease; Cholecystokinin; Diabetes Mellitus; Diagnosis, Differential; Female; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Pancreatic Juice; Pancreatitis; Secretin

Topics: Atropine; Calcinosis; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Humans; Hyperthyroidism; Lipase; Pancreatitis; Papaverine; Radionuclide Imaging; Secretin