cholecystokinin and Chronic-Disease

The liver adaptively responds to extra-intestinal and intestinal inflammation. In recent years, the role of the autonomic nervous system, intestinal failure and gut microbiota has been investigated in the development of hepatic, intestinal and extra-intestinal disease.. The autonomic nervous system can be stimulated via enteral fat leading to cholecystokinin release, stimulating receptors in the gut and in the brain. This promotes bowel integrity, dampening the inflammatory response to food antigens. Consensus exists that intravenously administered long-chain fatty acids can cause liver damage but randomized-controlled trials are lacking. Disruption of the enterohepatic circulation of bile salts can give rise to cholestasis and nonalcoholic fatty liver disease, which may progress to fibrosis and cirrhosis. Reduced intestinal availability of bile salts reduces stimulation of the farnesoid X receptor. This may induce hepatic bile salt overload and associated hepatotoxicity through reduced action of intestinal fibroblast growth factor 19. Evidence is put forward to suggest that the intestinal microbiota is associated with liver abnormalities.. Enteral lipids reduce inflammation and liver damage during stress or systemic inflammation, whereas parenteral lipid is associated with liver damage. Maintaining the enterohepatic circulation of bile salts limits hepatic cholestasis through an farnesoid X receptor feedback pathway. Changes in gut microbiota composition may induce liver disease.

Topics: Administration, Intravenous; Bile Acids and Salts; Cholecystokinin; Cholestasis; Chronic Disease; Fatty Acids; Fatty Acids, Omega-3; Fatty Liver; Gastrointestinal Tract; Humans; Intestinal Diseases; Liver; Metabolic Syndrome; Microbiota; Non-alcoholic Fatty Liver Disease

Since the early 1980s interventions have been used in conjunction with (99m)Tc-iminodiacetic acid (IDA) radiopharmaceuticals in many different clinical situations, eg, to prepare the patient for the study, to reduce the time of a study, to improve its diagnostic accuracy, and to make diagnoses not otherwise possible. Interventions all have underlying physiological rationales. Some of these interventions are as simple as having the patient fast before the study or eat a meal with high fat content. However, most are pharmacologic interventions, eg, morphine sulfate, cholecystokinin, and phenobarbital. Although these are probably the most common interventions used today, numerous other interventions have been used during the years and likely will be in the future. Interventions have aided in the diagnosis of acute cholecystitis, chronic cholecystitis, biliary obstruction, and sphincter of Oddi dysfunction. This review will discuss in detail the interventions commonly is use today and in somewhat less detail many that have been successfully used on an investigational basis and may have some larger role in the future.

Topics: Biliary Tract Diseases; Cholecystitis; Cholecystitis, Acute; Cholecystokinin; Chronic Disease; Gallbladder Emptying; Humans; Morphine; Radionuclide Imaging; Radiopharmaceuticals; Sincalide; Technetium Tc 99m Diethyl-iminodiacetic Acid

The clinical utility of cholecystokinin-cholescintigraphy with calculation of a gallbladder ejection fraction (GBEF) in patients with suspected chronic acalculous gallbladder dysfunction (CAGD) remains controversial. It was our aim to critically evaluate the literature on the utility of the GBEF to predict outcome of patients with suspected CAGD. We performed an electronic search of the MEDLINE database for articles published between 1980 and 2002 and a manual search of references from bibliographies of identified articles. Only articles in English that concerned adults were screened. Data extracted included both qualitative and quantitative data reported on the study groups, cholescintigraphic technique, interventions, treatment outcomes, and trial methodologic characteristics. Twenty-three publications met the inclusion criteria. All were considered of poor methodologic quality. All but three studies were retrospective case series, only one was randomized, and none were adequately blinded, used adequate controls, or enrolled a sufficient number of patients. Five studies used a cut-off value for an abnormal GBEF that was different than the value used by the others, one study did not provide a cut-off value, and several did not report details of the cholescintigraphic technique (namely, the rate of cholecystokinin infusion). Studies varied in their outcome measures and the criteria for success. The overall assessment of outcome in 19 studies concluded that calculation of a GBEF was useful in patients with suspected CAGD. The low methodologic quality of the studies precluded a meta-analysis approach to the data. Use of a calculated GBEF to diagnose and predict treatment outcome in suspected CAGD has not been adequately studied. Although most studies report utility of GBEF in predicting symptom outcome after cholecystectomy in patients with suspected CAGD, quality evidence is lacking, thereby precluding a definitive recommendation regarding its use. More high quality trials are needed.

Topics: Cholecystectomy; Cholecystokinin; Chronic Disease; Gallbladder Diseases; Gallbladder Emptying; Humans; Radionuclide Imaging; Radiopharmaceuticals

It is well established that cholecystokinin (CCK) reduces the antinociceptive effect of opioids. The level of CCK and CCK receptors, as well as CKK release, exhibits considerable plasticity after nerve injury and inflammation, conditions known to be associated with chronic pain. Such altered CCK release coupled in some situation with changes in CCK receptor levels may underlie the clinical phenomenon of varying opioid sensitivity in different clinical pain conditions. In particular, neuropathic pain after injury to the peripheral and central nervous system does not respond well to opioids, which is likely to be caused by increased activity in the endogenous CCK system. CCK receptor antagonists may thus be useful as analgesics in combination with opioids to treat neuropathic pain.

Topics: Analgesia; Animals; beta-Endorphin; Cholecystokinin; Chronic Disease; Humans; Inflammation; Morphine; Pain; Rats; Receptors, Cholecystokinin; Spinal Cord Injuries

Cholecystokinin (CCK) is a major gastrointestinal hormone that plays an important role in stimulation of pancreatic secretion and gall-bladder contraction, regulation of gastrointestinal motility and induction of satiety. Ingestion of fat and protein induces significant increases in plasma CCK. Intraluminal mediators of CCK secretion, luminal CCK releasing factor and diazepam-binding inhibitor, were purified from rat intestinal secretion. These CCK-releasing factors (RF) are secreted tonically by the small intestine and stimulate CCK release. Another kind of CCK-RF named 'monitor peptide' was purified from the rat pancreatic juice that stimulates CCK secretion when introduced into rat intestine. Bile exclusion from the duodenum causes an increase in basal CCK and enhances stimulated plasma CCK release, and bile salt replacement reverses these effects. Thus, the CCK-RF are spontaneously secreted into the intestinal lumen in humans, while the CCK-producing cells are under constant suppression by intraduodenal bile acids. In acute pancreatitis, plasma CCK levels are high in patients with gallstone pancreatitis, but not in patients with pancreatitis from other causes, such as alcoholic and idiopathic pancreatitis. A transient disturbance of bile flow into the duodenum by stones or oedema of the pancreas together with impairment of pancreatic exocrine function might cause the increase in plasma CCK release in gallstone pancreatitis. Patients with chronic pancreatitis with mild to moderate impairment of exocrine function and abdominal pain, had significantly higher plasma CCK concentrations, whereas patients with pancreatic insufficiency had a significantly lower plasma CCK response to a test meal than the healthy subjects. The increased CCK may further aggravate pancreatitis and worsen the prognosis of pancreatitis by stimulating the injured pancreas, resulting in the vicious circle via endogenous CCK release. The CCK-A receptor antagonist might be therapeutically useful in acute pancreatitis by stopping the vicious circle.

Topics: Acute Disease; Bile Acids and Salts; Cholecystokinin; Chronic Disease; Humans; Pancreatitis

Helicobacter pylori infection affects the concentration of regulatory peptides such as gastrin, somatostatin and cholecystokinin and the concentration and activity of glutathione and glutathione S-transferases in the gastric mucosa.. Literature review.. Although some of these peptides have been known since the beginning of this century, their action has changed since the discovery of H. pylori infection in 1983. Chronic infection with H. pylori might lead to an increased risk in developing gastric cancer. Glutathione S-transferases are involved in the cellular detoxification of xenobiotics and other toxic compounds. Since there is a close inverse relationship between the activity of glutathione S-transferase and incidence of malignancies in the gastrointestinal tract, the possible relation between H. pylori infection and activity of glutathione S-transferases in the gastric mucosa is discussed.. The effect of H. pylori infection on regulatory peptides and glutathione/glutathione S-transferases might play a role in the development of neoplastic changes of the H. pylori-infected gastric mucosa.

Topics: Animals; Biomarkers; Cholecystokinin; Chronic Disease; Disease Progression; Gastric Mucosa; Gastrins; Gastritis; Glutathione; Glutathione Transferase; Helicobacter Infections; Helicobacter pylori; Humans; Somatostatin; Stomach Neoplasms

According to the concept of negative feedback regulation of pancreatic enzyme secretion by proteases, treatment with pancreatic extracts has been proposed to lower pain in chronic pancreatitis by decreasing pancreatic duct pressure. The author, however, has demonstrated in healthy volunteers that intraduodenal application of porcine pancreatic extracts does not inhibit but rather stimulates pancreatic enzyme secretion. This is probably because of the high-protein content of porcine pancreatic extracts that may overwhelm a potential inhibitory effect of proteases. In a prospective placebo-controlled, double-blind multicenter study to investigate the effect of acid-protected porcine pancreatic extracts on pain in 43 patients with chronic pancreatitis, pain improved in most patients regardless of whether they started with placebo or verum. There was no significant difference between both treatment arms. In a meta-analysis, which included the author's study, six randomized, double-blind, placebo-controlled studies were evaluated. Statistical analysis demonstrated no benefit of the application of porcine pancreatic extracts to relieve pain in chronic pancreatitis. The author concluded that pancreatic extracts neither inhibit pancreatic enzyme secretion nor are they efficient in lowering pain in chronic pancreatitis.

Topics: Animals; Cholecystokinin; Chronic Disease; Feedback; Humans; Pain; Pancreatic Extracts; Pancreatitis

Topics: Acute Disease; Cholecystokinin; Chronic Disease; Humans; Pancreatitis

This article reviews the evolution of functional testing of the pancreas in Japan for the diagnosis and treatment of chronic pancreatitis (CP), contrasting the pre- with the postsecretin test (S test) era. In the pre-S test era, the diagnosis was based on symptoms, clinical findings, fasting serum diastase levels, and the vagostigmin- and ether-stimulation test unless morphologic evidence was available. The S test and CCK-pancreozymin (PZ) test (PS test) were introduced into Japan around 1963 and have been used as the gold standard of the exocrine pancreatic-function test. Through a series of attempts at standardization in 1971, 1985, and 1987, the method was standardized to collect duodenal juice for 60 min through a double- or triple-lumen tube after a bolus or during a continuous i.v. injection of secretin (100 U). The S test, however, is an invasive and cumbersome procedure. As a result, N-benzoyl-L-tyrosal-p-aminobenzoic acid (BT-PABA) testing and fecal chymotrypsin testing were introduced into Japan in the middle and late 1970s, respectively. Although simple and noninvasive, these two methods were found have lower sensitivity and specificity than the conventional S test. These two methods, therefore, are presently used more often for monitoring the course of disease and therapeutic effects. Additionally, the glucose tolerance test can be performed to detect endocrine pancreatic insufficiency.

Topics: 4-Aminobenzoic Acid; Absorption; Cholecystokinin; Chronic Disease; Digestion; Humans; Islets of Langerhans; Japan; Pancreatitis; para-Aminobenzoates; Secretin

Topics: Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystokinin; Cholelithiasis; Chronic Disease; Humans; Sensitivity and Specificity

We sought to determine whether a reduced gallbladder ejection fraction, (GBEF) ascertained by cholecystokinin-cholescintigraphy (CCK-CS), predicts symptomatic improvement after cholecystectomy.. Medical records of patients who had had CCK-CS as well as negative results of gallbladder ultrasonography were reviewed, and patients were contacted by telephone to determine whether they had benefited from cholecystectomy.. There were 35 patients (33 female, 2 male) who had a decreased GBEF. Cholecystectomy was done in 30, of whom 20 (67%) had resolution of pain, 8 (27%) had partial improvement, and 2 (7%) had no change. The 5 who declined cholecystectomy included none (0%) who were pain free, 2 (40%) who had partial improvement, and 3 (60%) who had no change. The clinical outcome of the two groups was significantly different. There were 14 patients (10 female, 4 male) with a normal GBEF. The 2 patients who had cholecystectomy were asymptomatic. Of the 12 patients who did not have cholecystectomy, 9 (75%) were asymptomatic, 1 (8%) had some improvement, and 2 (17%) had no change.. Cholecystectomy is indicated for patients with acalculous biliary pain and reduced GBEF, since symptoms will likely resolve with surgery and will persist without it. Cholecystectomy for patients with a normal GBEF should be considered only after failure of a nonoperative trial, since improvement usually occurs over time.

Topics: Adolescent; Adult; Aged; Child; Cholecystectomy; Cholecystitis; Cholecystokinin; Chronic Disease; Colic; Female; Follow-Up Studies; Forecasting; Gallbladder; Gallbladder Diseases; Gallbladder Emptying; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Remission Induction; Retrospective Studies; Technetium Tc 99m Disofenin; Telephone; Treatment Outcome; Ultrasonography

Topics: Acute Disease; Cholecystokinin; Chronic Disease; Humans; Pancreatitis

The role of nitrate compounds in the therapy of pancreatic diseases is discussed in this review. A short overview is given about the physiological background of the treatment: the regulation of Oddi's sphincter function and its pharmacology. An adjuvant role is attributed to the free outflow of pancreatic secretion in the treatment of pancreatic pain and in the prevention of relapses. The authors describe their clinical practice during the last 15 years: nitrates with short half-life in the treatment of acute pancreatitis (amylnitrit or nitroglycerin spray) which have a low risk of developing nitrate tolerance; chronic administration of retard nitroglycerin in chronic pancreatitis and Oddi's sphincter hypertonic dyskinesia. For preventing the induction of nitrate tolerance, Nitromint retard is recommended twice a day combined with a calcium antagonist or with theophylline during the nitrate-free period.

Topics: Acute Disease; Ampulla of Vater; Blood Glucose; Calcium Channel Blockers; Cholecystokinin; Chronic Disease; Drug Tolerance; Humans; Nitroglycerin; Pancreatitis; Parasympatholytics; Theophylline

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreatitis; Secretin

Topics: Animals; Cholecystokinin; Chronic Disease; Chymotrypsin; Enzyme Therapy; Exocrine Pancreatic Insufficiency; Feedback; Female; Humans; Male; Pain; Pancreas; Pancreatitis; Rats; Trypsin

The action of acute and chronic administration of ethanol on pancreatic exocrine secretion in humans and several animal species is reviewed. If the data concerning the secretory action of ethanol on the pancreas are to the property assessed, several experimental variables have to be considered. Acute intravenous administration of ethanol inhibits basal and hormonally stimulated pancreatic secretion of bicarbonate and protein in nonalcoholic humans and most species of animals tested. Oral or intraduodenal ethanol causes moderate stimulation of pancreatic bicarbonate and enzyme secretion. Since anticholinergic agents and truncal vagotomy diminish the ethanol-induced inhibition of pancreatic secretion in the intact animal, it is possible that the action of ethanol on the pancreas is at least partly mediated by inhibitory cholinergic mechanisms. The action of ethanol on the pancreas may also be mediated by release of gastrointestinal hormones. Intravenous and oral administration of ethanol releases gastrin in dogs but not in humans. Pancreatic polypeptide is unlikely to be the hormonal mediator of the ethanol-induced inhibition of exocrine pancreatic secretion in humans and dogs, since ethanol does not release pancreatic polypeptide. The main secretory changes induced by chronic alcoholism in humans and dogs are increased basal secretion of pancreatic enzymes and decreased basal bicarbonate output, and these secretory changes may favour the occurrence of protein precipitates which are believed to be the first lesion of chronic pancreatitis in man. A decrease in the concentration of "pancreatic stone protein" in pancreatic juice may favour the development of protein precipitates in chronic alcoholic patients.

Topics: Acute Disease; Alcoholism; Animals; Calcium-Binding Proteins; Cholecystokinin; Chronic Disease; Dogs; Duodenum; Ethanol; Food; Gastric Juice; Gastrins; Gastrointestinal Hormones; Humans; Lithostathine; Nerve Tissue Proteins; Pancreas; Pancreatic Juice; Pancreatic Polypeptide; Pancreatitis; Secretin; Sphincter of Oddi; Stomach

Topics: 4-Aminobenzoic Acid; Cholecystokinin; Chronic Disease; Enzymes; Feces; Fluoresceins; Humans; Pancreas; Pancreatic Function Tests; Pancreatic Polypeptide; Pancreatitis; Schilling Test; Secretin

Topics: Animals; Cholecystokinin; Chronic Disease; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Glucagon; Humans; Insulin; Insulin Secretion; Pancreatic Hormones; Pancreatic Polypeptide; Pancreatitis

Topics: Cholecystokinin; Chronic Disease; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Glucagon; Humans; Insulin; Pancreatic Hormones; Pancreatic Polypeptide; Pancreatitis; Secretin

The diagnosis of both acute and chronic pancreatitis continues to be a challenge despite the development of new techniques and the refinement of old methods. The problem is best approached by the application of a combination of tests which can provide a reasonable degree of sensitivity and specificity applicable to the different forms of pancreatitis. In acute pancreatitis an elevation of serum amylase and amylase/creatinine clearance ratio is diagnostically useful. In chronic pancreatitis, several tests are needed to enhance the diagnostic yield, and such tests can include the secretin-pancreozymin test, ERCP, fecal fat measurement, Lundh test meal, and the administration of the synthetic peptide BZ-Ty-PABA.

Topics: Acute Disease; Amylases; Cholecystokinin; Chronic Disease; Creatinine; Feces; Food; Humans; Pancreas; Pancreatic Juice; Pancreatitis; Peptides; Radiography; Secretin

Topics: Anticonvulsants; Cholecystokinin; Chronic Disease; Humans; Oxazoles; Pancreas; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin; Trimethadione

Topics: Acute Disease; Adolescent; Adult; Angiography; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatitis; Plasma Substitutes; Radioisotopes; Radionuclide Imaging; Secretin; Selenium

Topics: Acute Disease; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Diabetes Complications; Diabetes Mellitus; Diabetes Mellitus, Type 1; Diabetic Angiopathies; Humans; Insulin; Islets of Langerhans; Lipase; Middle Aged; Pancreas; Pancreatic Juice; Pancreatitis; Secretin

Topics: Acute Disease; Adenoma, Islet Cell; Cholecystokinin; Chronic Disease; Gastrins; Humans; Methods; Pancreas; Pancreas Transplantation; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Radiography; Secretin; Transplantation, Homologous; Zollinger-Ellison Syndrome

Topics: Amylases; Cholecystokinin; Chronic Disease; Pancreatitis; Radiography

To characterize cholagenic diarrhea as a nosological entity with its specific features of etiology, pathogenesis, clinical picture and treatment.. A total of 167 patients with chronic diarrhea (CD) participated in the trial. Of them, 25 patients have undergone resection of the small intestine, 98--cholecystectomy for cholelithiasis, 44 had concurrent hypokinesia of the gall bladder caused by celiac disease (n = 30) or biliary dyskinesia (n = 14). The examination included estimation of cholic acid in the duodenal content (40% glucose solution or cholecystokinin were used as stimulators); 24-h fecal mass; fecal mass for 24 hours, fat, potassium and sodium content in the feces; electromotor activity (EMA) of the gall bladder, small intestine and colon.. Duodenal intubation with 40% glucose in patients with extensive resection of the small intes- tine detected a fall in cholic acid content in vesical bile to 408 +/- 58.39 mg compared to normal (910 +/- 97.29 mg%). In intravenous administration of cholecystokinin cholic acid concentration rose insignificantly (547.0 +/- 94.7 mg%) and was accompanied with bile loss with feces, polyfecalia, steatorrhea and high sodium concentration in feces. In celiac disease patients bile with high cholic acid concentration was secreted only in administration of cholecystokinin (1673 +/- 175.9 mg/%, normal 1701 +/- 140.6 mg/%). In patients after cholecystectomy colon EMA was primarily slow-wave and middle-amplitude, typical for hypermotor dyskinesia.. CD develops after extensive resection and in inflammatory ileac diseases, suppression of contractile function of the gall bladder and after cholecystectomy. CD after cholecystectomy can be considered as a variant of postcholecystectomy syndrome. The treatment of CD should include drugs binding excessive bile acids in the colon, in hypokinesia of the gall bladder the treatment should include stimulators of its contractile function.

Topics: Adolescent; Adult; Cholagogues and Choleretics; Cholecystokinin; Chronic Disease; Diagnosis, Differential; Diarrhea; Digestive System Surgical Procedures; Female; Humans; Ileal Diseases; Ileum; Injections, Intravenous; Male; Middle Aged; Postoperative Complications; Prognosis

Over 500,000 patients undergo cholecystectomy annually in the United States for symptoms of upper abdominal discomfort and pain ascribed to gallbladder disease. However, approximately 5%, or 25,000 of these cases do not have gallstones on ultrasound examination but typically present with chronic symptoms of biliary colic. These patients often present as challenging diagnostic dilemmas and are often treated as if their symptoms are secondary to peptic ulcer disease or other gastrointestinal-related disorders. In 1992, we began to use the cholecystokinin (CCK) challenge test on patients with normal ultrasound examinations of the gallbladder but who had chronic symptoms resembling biliary colic. The CCK test was considered positive if the identical symptoms of discomfort or pain, usually in the right upper quadrant of the abdomen, were reproduced. This study describes the first 24 patients who had a positive CCK challenge test and chose to undergo cholecystectomy for relief of their symptoms. No patient was lost to follow-up evaluation at 1 to 24 months after operation.

Topics: Abdominal Pain; Adult; Aged; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholecystokinin; Chronic Disease; Colic; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement

The analgesic efficacy of morphine is sometimes only partial in patients with chronic benign pain. Among the possible factors contributing to this limitation are increased levels of cholecystokinin (CCK). We performed this prospective, placebo-controlled, double-blind, cross-over study to examine the effect of proglumide, a nonspecific CCK agonist, on analgesia in patients taking morphine on a chronic basis. Forty patients with intractable pain who were taking sustained-release morphine were recruited, and we obtained results from 36 of these patients. Median visual analog scale scores before the study were 8 and 7 after the addition of placebo for 2 wk (P = 0.16), and 6 after proglumide for 2 wk (P = 0.002). Mobility was unchanged by proglumide or placebo. Of the 36 patients, 13 elected to continue receiving proglumide after the study. We conclude that proglumide enhances the analgesia produced by morphine in some, but not all, patients with chronic benign pain.. The pain-killing effect of morphine is incomplete in some patients. Increasing doses may be needed to maintain the initial effect. The peptide cholecystokinin may be partially responsible for this. In this study, we demonstrated that the cholecystokinin antagonist proglumide increases the analgesic effect of morphine in some patients with chronic benign pain.

Topics: Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Cholecystokinin; Chronic Disease; Cross-Over Studies; Double-Blind Method; Drug Synergism; Female; Humans; Male; Middle Aged; Morphine; Pain; Pain Measurement; Proglumide

After pylorus-preserving Whipple (PPW), delayed gastric emptying (DGE) is reported in up to 50% of these patients. We analyzed gastric emptying and hormonal adaptation of cholecystokinin (CCK), pancreatic polypeptide (PP), and gastrin following two surgical procedures for chronic pancreatitis (CP): the PPW and the duodenum-preserving pancreatic head resection (DPPHR).. Ten patients underwent DPPHR and 10 underwent PPW for CP. Preoperatively and 10 days and 6 months postoperatively, gastric emptying (paracetamol absorption test) and CCK, gastrin, and PP were measured using a test meal stimulation.. The area under the serum paracetamol time curve for 0 to 120 minutes (AUC) showed no preoperative difference. Ten days postoperatively, the AUC was significantly reduced (P <0.05) after PPW but not after DPPHR. Six months postoperatively, AUC was comparable with the preoperative findings in DPPHR and PPW. The integrated 180-minute PP release was significantly reduced 10 days and 6 months postoperatively in both groups. The integrated 180-minute CCK release was decreased 10 days after PPW, but failed to be significant (P = 0.053). Gastrin levels were postoperatively unchanged.. Following DPPHR we found no delay in gastric emptying. In contrast, DGE occurs early after PPW. Our data may help explain the slower recovery in PPW patients with regard to weight gain and relief from pain, which may be due to the functional alteration of gastric emptying and motility after this type of surgery.

Topics: Acetaminophen; Adult; Cholecystokinin; Chronic Disease; Female; Gastric Emptying; Gastrins; Humans; Male; Middle Aged; Pancreatic Polypeptide; Pancreaticoduodenectomy; Pancreatitis; Postoperative Complications

This study was aimed to investigate the effect of long-term treatment with high-protease pancreatic extract on the recurrent abdominal pain of patients with chronic pancreatitis.. Twenty-six patients with a firm diagnosis of chronic pancreatitis and a pattern of recurrent pain were recruited and randomly assigned to treatment with pancreatic extract (Pancrex-Duo capsules, each containing 34,375 USP units of protease in enteric-coated microspheres) or placebo, at a dose of four capsules four times daily, for 4 months. At the end of the first period patients were switched to the other medication for the next 4 months. Four patients did not complete the study because of unbearable recurring pain or inadequate compliance with treatment. The other 22 patients daily recorded the presence, intensity, and duration of pain and the consumption of analgesics, for 8 months.. No difference was found when intraindividual records during placebo and extract treatment periods were compared. Conversely, in the second 4 months of follow-up, regardless of the treatment given in the first period, there was a significant reduction in the cumulative pain score (median, 95; range, 0-1005, versus 134; 0-972; p < 0.05), in the number of days (8; 0-132, versus 13; 0-126; p < 0.02) and hours (54; 0-680, versus 80; 0-602; p < 0.05) of pain, and in the analgesic consumption score (0; 0-22, versus 12; 0-44; p = 0.02).. Chronic supplementation with pancreatic extract is not beneficial in the management of recurrent pain in patients with chronic pancreatitis.

Topics: Abdominal Pain; Adult; Aged; Analysis of Variance; Cholecystokinin; Chronic Disease; Cross-Over Studies; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain Measurement; Pancreatic Extracts; Pancreatitis; Recurrence; Time Factors

In lumbar cerebrospinal fluid (CSF) obtained from patients with chronic tension-type headache (CTH), the concentrations of beta-endorphin, met-enkephalin, dynorphin, cholecystokinin (CCK), calcitonin gene-related peptide (CGRP), and somatostatin were measured before and after 8 weeks of treatment with sulpiride or paroxetine. We previously reported higher than normal met-enkephalin concentrations in CTH. The present study reveals normal basal concentrations of CCK, CGRP and somatostatin and slightly decreased dynorphin in the same patients. Treatment with sulpiride or paroxetine did not change the concentration of any of the neuropeptides measured. These data suggest central changes in opioid systems but not in other peptide systems (CCK, CGRP, somatostatin) involved in nociceptive processing at the level of the spinal cord dorsal horn/nucleus caudalis of the trigeminal nerve in CTH. Such central changes might be pathophysiologically important or merely secondary to other more important occurrences. The lack of changes in neuropeptide concentrations during drug treatment makes planning of studies involving CSF analysis easier, but also limits the probability of obtaining information on specific neuropeptide systems through CSF analysis.

Topics: Adult; Aged; Basal Metabolism; Calcitonin Gene-Related Peptide; Cholecystokinin; Chronic Disease; Dopamine D2 Receptor Antagonists; Dynorphins; Female; Humans; Male; Middle Aged; Neuropeptides; Paroxetine; Somatostatin; Sulpiride; Tension-Type Headache

Topics: Adult; Ceruletide; Cholecystokinin; Chronic Disease; Clinical Trials as Topic; Female; Humans; Long-Term Care; Male; Middle Aged; Psychiatric Status Rating Scales; Schizophrenia

The clinical usefulness of a simple exocrine pancreatic function diagnostic test (PFT) was examined by the oral administration of 500 mg of N-benzoyl-L-tyrosyl-p-aminobenzoic acid. Recovery of p-aminobenzoic acid (PABA) in the urine was significantly lower in patients with calcifying chronic pancreatitis (58.6%) and noncalcifying chronic pancreatitis (68.6%) than in healthy normal subjects (81.0%; p less than 0.001 and p less than 0.05, respectively). Abnormally low values were demonstrated in 15 out of 19 (78.9%) chronic pancreatitis cases. In comparing the PFT with the pancreozymin secretin test, a good correlation (P less than 0.001) with maximum bicarbonate concentration was detected. In cases which were abnormal with respect to the PFT, the recovery rate of PABA was increased by the administration of antacids or digestive enzyme preparations (average increase of 24.1 or 29.8%, respectively). These results suggest that this test is also useful for the evaluation of therapeutic effects in patients with pancreatic diseases.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Cholecystokinin; Chronic Disease; Clinical Trials as Topic; Humans; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates

Topics: Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Clinical Trials as Topic; Enzyme Activation; Hepatitis; Humans; Lipase; Pancreas; Secretin; Time Factors; Trypsin

Secretin (1 CU/Kg) plus Caerulein (100 ng/Kg) or Cholecystokinin (1 or 2 IvyU/Kg) were given by rapid intravenous injection (Schedule 1) or by continuous infusion (Schedule 2) to 63 control subjects (C) and 69 patients affected by chronic pancreatitis (CP). Duodenal juice was collected for two and four 30-minute periods in schedule 1 and schedule 2, respectively. Volume, bicarbonate, and enzyme content were measured. Secretin-Daerulein, by rapid intravenous injection, showed a strong overlapping between C and CP values and led to some side-effects. Secretin-Caerulein by continuous intravenous infusion gave almost identical results as the Secretin-Cholecystokinin.

Topics: Adolescent; Adult; Aged; Bicarbonates; Ceruletide; Cholecystokinin; Chronic Disease; Clinical Trials as Topic; Duodenum; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pancreas; Pancreatic Juice; Pancreatitis; Secretin

Decreased medial prefrontal cortex (mPFC) neuronal activity is associated with social defeat-induced depression- and anxiety-like behaviors in mice. However, the molecular mechanisms underlying the decreased mPFC activity and its prodepressant role remain unknown. We show here that induction of the transcription factor ΔFosB in mPFC, specifically in the prelimbic (PrL) area, mediates susceptibility to stress. ΔFosB induction in PrL occurred selectively in susceptible mice after chronic social defeat stress, and overexpression of ΔFosB in this region, but not in the nearby infralimbic (IL) area, enhanced stress susceptibility. ΔFosB produced these effects partly through induction of the cholecystokinin (CCK)-B receptor: CCKB blockade in mPFC induces a resilient phenotype, whereas CCK administration into mPFC mimics the anxiogenic- and depressant-like effects of social stress. We previously found that optogenetic stimulation of mPFC neurons in susceptible mice reverses several behavioral abnormalities seen after chronic social defeat stress. Therefore, we hypothesized that optogenetic stimulation of cortical projections would rescue the pathological effects of CCK in mPFC. After CCK infusion in mPFC, we optogenetically stimulated mPFC projections to basolateral amygdala or nucleus accumbens, two subcortical structures involved in mood regulation. Stimulation of corticoamygdala projections blocked the anxiogenic effect of CCK, although no effect was observed on other symptoms of social defeat. Conversely, stimulation of corticoaccumbens projections reversed CCK-induced social avoidance and sucrose preference deficits but not anxiogenic-like effects. Together, these results indicate that social stress-induced behavioral deficits are mediated partly by molecular adaptations in mPFC involving ΔFosB and CCK through cortical projections to distinct subcortical targets.

Topics: Animals; Anti-Anxiety Agents; Anxiety Disorders; Brain Mapping; Cholecystokinin; Chronic Disease; Depressive Disorder; Indoles; Limbic System; Male; Meglumine; Mice; Mice, Inbred C57BL; Neural Pathways; Prefrontal Cortex; Proto-Oncogene Proteins c-fos; Receptor, Cholecystokinin B; Social Dominance; Stress, Psychological

Unilateral constrictive sciatic nerve injury (uCCI) is a common neuropathic pain model. However, the bilateral constrictive injury (bCCI) model is less well studied, and shows unique characteristics. In the present study, we sought to correlate effects of bCCI on nocifensive responses to cold and mechanical stimuli with selected dorsal horn anatomic markers. bCCI or sham ligation of both rat sciatic nerves were followed up to 90 days of behavioural testing. Additional rats sacrificed at 15, 30 and 90 days were used for anatomic analyses. Behavioural tests included hindpaw withdrawal responses to topical acetone, cold plate testing, an operant thermal preference task and hindpaw withdrawal thresholds to mechanical probing.. All nocifensive responses to cold increased and remained enhanced for >45 days. Mechanical withdrawal thresholds decreased for 25 days only. Densitometric analyses of immunoperoxidase staining in the superficial dorsal horn at L4-5 revealed decreased cholecystokinin (CCK) staining at all times after bCCI, decreased mu opiate receptor (MOR) staining, maximal at 15 days, increased neuropeptide Y (NPY) staining only at days 15 and 30, and increased neurokinin-1 receptor (NK-1R) staining at all time points, maximal at 15 days. Correlation analyses at 45 days post-bCCI, were significant for individual rat nocifensive responses in each cold test and CCK and NK-1R, but not for MOR or NPY.. These results confirm the usefulness of cold testing in bCCI rats, a new approach using CCI to model neuropathic pain, and suggest a potential value of studying the roles of dorsal horn CCK and substance P in chronic neuropathic pain. Compared to human subjects with neuropathic pain, responses to cold stimuli in rats with bCCI may be a useful model of neuropathic pain.

Topics: Acetone; Analgesics; Animals; Biomarkers; Cholecystokinin; Chronic Disease; Cold Temperature; Disease Models, Animal; Female; Functional Laterality; Hyperalgesia; Immunohistochemistry; Ligation; Neuropeptide Y; Pain Measurement; Pain Threshold; Peripheral Nervous System Diseases; Posterior Horn Cells; Predictive Value of Tests; Rats; Rats, Sprague-Dawley; Receptors, Neurokinin-1; Receptors, Opioid, mu; Reflex; Sciatic Neuropathy

Chronic cholangitis caused by hepatolithiasis is a common disease in Southeast Asia. Few studies have addressed the effects of chronic cholangitis on cyclic activity of the sphincter of Oddi (SO). In this study, we investigated the changes of myoelectric activity in rabbits with chronic cholangitis in vivo and in vitro.. Chronic cholangitis was induced in rabbits by initially introducing three pieces of 2-0 silk suture and sequentially injecting E. coli into the choledochus through the tube in ductus cysticus. In in vivo experiments, myoelectric activity of SO was recorded by a circular electrode through the jejunum stump in conscious animals. In in vitro experiments, the SO was completely isolated and the myoelectric activity was recorded by a circular electrode in a 10-mL organ bath filled with Krebs solution, with or without addition of cholecystokinin-8 (CCK-8), KCl, ionomycin or induction of capacitative calcium entry (CCE).. In comparison with control and non-infected rabbits, the rabbits with chronic cholangitis showed higher levels of alkaline phosphatase and gamma-glutamyltransferase and significant pathological changes including increased inflammatory infiltration and collagen deposition in mucosae or muscular layer. Cyclic myoelectric activity of SO at phases 2 and 3 of migrating motor complex and the excitatory response to CCK-8 were dramatically decreased in animals with chronic cholangitis. Myoelectric activity of SO was also significantly decreased in vitro with or without agonists or with induction of CCE.. Myoelectric activity of SO and its response to agonists are decreased in rabbits with chronic cholangitis both in vivo and in vitro.

Topics: Animals; Calcium; Cholangitis; Cholecystectomy; Cholecystokinin; Chronic Disease; Electromyography; Muscle Contraction; Muscle, Smooth; Peptide Fragments; Rabbits; Random Allocation; Sphincter of Oddi

To investigate chronic stress as a susceptibility factor for developing pancreatitis, as well as tumor necrosis factor-α (TNF-α) as a putative sensitizer.. Rat pancreatic acini were used to analyze the influence of TNF-α on submaximal (50 pmol/L) cholecystokinin (CCK) stimulation. Chronic restraint (4 h every day for 21 d) was used to evaluate the effects of submaximal (0.2 μg/kg per hour) cerulein stimulation on chronically stressed rats.. In vitro exposure of pancreatic acini to TNF-α disorganized the actin cytoskeleton. This was further increased by TNF-α/CCK treatment, which additionally reduced amylase secretion, and increased trypsin and nuclear factor-κB activities in a protein-kinase-C δ and ε-dependent manner. TNF-α/CCK also enhanced caspases' activity and lactate dehydrogenase release, induced ATP loss, and augmented the ADP/ATP ratio. In vivo, rats under chronic restraint exhibited elevated serum and pancreatic TNF-α levels. Serum, pancreatic, and lung inflammatory parameters, as well as caspases'activity in pancreatic and lung tissue, were substantially enhanced in stressed/cerulein-treated rats, which also experienced tissues' ATP loss and greater ADP/ATP ratios. Histological examination revealed that stressed/cerulein-treated animals developed abundant pancreatic and lung edema, hemorrhage and leukocyte infiltrate, and pancreatic necrosis. Pancreatitis severity was greatly decreased by treating animals with an anti-TNF-α-antibody, which diminished all inflammatory parameters, histopathological scores, and apoptotic/necrotic markers in stressed/cerulein-treated rats.. In rats, chronic stress increases susceptibility for developing pancreatitis, which involves TNF-α sensitization of pancreatic acinar cells to undergo injury by physiological cerulein stimulation.

Topics: Actins; Adenosine Diphosphate; Adenosine Triphosphate; Amylases; Animals; Antibodies; Calcium Signaling; Caspases; Ceruletide; Cholecystokinin; Chronic Disease; Cytoskeleton; Disease Models, Animal; Enzyme Activation; Lung Injury; Male; Necrosis; NF-kappa B; Pancreas, Exocrine; Pancreatitis; Protein Kinase C-delta; Protein Kinase C-epsilon; Protein Transport; Rats; Rats, Wistar; Restraint, Physical; Severity of Illness Index; Stress, Psychological; Tissue Culture Techniques; Trypsin; Tumor Necrosis Factor-alpha

It is unclear why patients with inflammation of the distal bowel complain of symptoms referable to the upper gastrointestinal tract, specifically to gastric emptying (GE) disturbances. Thus we aimed to determine occurrence and putative pathomechanisms of gastric motor disorders in such patients. Thirteen healthy subjects (CON), 13 patients with Crohn's disease (CD), 10 with ulcerative colitis (UC), and 7 with diverticulitis (DIV) underwent a standardized (13)C-octanoic acid gastric emptying breath test. Plasma glucose, CCK, peptide YY, and glucagon-like peptide-1 (GLP-1) were measured periodically and correlated with GE parameters. Results were given in means +/- SD. Compared with CON, GE half time (T) was prolonged by 50% in CD (115 +/- 55 vs. 182 +/- 95 min, P = 0.037). Six CD, 2 DIV, and 2 UC patients had pathological T (>200 min). Postprandial plasma glucose was increased in all patients but was highest in DIV and correlated with T (r = 0.90, P = 0.006). In CD, mean postprandial CCK levels were increased threefold compared with CON (6.5 +/- 6.7 vs. 2.1 +/- 0.6 pmol/l, P = 0.027) and were correlated with T (r = 0.60, P = 0.041). Compared with CON, GLP-1 levels were increased in UC (25.1 +/- 5.2 vs. 33.5 +/- 13.0 pmol/l, P = 0.046) but markedly decreased in DIV (9.6 +/- 5.2 pmol/l, P < 0.0001). We concluded that a subset of patients with CD, UC, or DIV has delayed GE. GE disturbances are most pronounced in CD and might partly be caused by excessive CCK release. In DIV there might be a pathophysiological link between decreased GLP-1 release, postprandial hyperglycemia, and delayed GE. These explorative data encourage further studies in larger patient groups.

Topics: Acute Disease; Adult; Aged; Blood Glucose; C-Reactive Protein; Cholecystokinin; Chronic Disease; Colitis, Ulcerative; Crohn Disease; Diverticulitis, Colonic; Fasting; Female; Gastric Emptying; Gastrointestinal Diseases; Glucagon-Like Peptide 1; Humans; Male; Middle Aged; Peptide YY; Postprandial Period; Steroids; Young Adult

To elicit the role of cholecistokinin (CCK), biogenic amines, bile acids (BA) in development of functional pancreatic insufficiency (PI) in chronic pancreatitis (CP).. Blood concentrations of CCK, serotonin and acetylcholin, fecal concentration of elastase (E-1), BA spectrum in the blood and duodenal content were studied in 46 CP patients (20 patients with alcoholic pancreatitis--AP and 26 patients with biliary pancreatitis--BP) and 15 healthy controls.. In AP patients E-1 fell to 78.4 +/- 6.3 mcg/g (severe exocrine PI), while in BP patients E-1 was 170.0 +/- 28.9 mcg/g. CCK in AP and BP decreased to 0.33 +/- 0.03 and 0.45 +/- 0.03 ng/ml, respectively (control--1.60 +/- 0.02 ng/ml, respectively, p < 0.05). AP and BP patients had a rise in the absolute concentration and percentage of the total fraction of the taurodioxicholanic acids to 10.2 +/- 1.6 and 15.0 +/- 2.3%, respectively, (control 9.5 +/- 1.2%) in duodenal bile. The concentration of glycocholic acid fell to 24.1 +/- 1.6 and 23.7 +/- 3.7%, respectively, (control--36.4 +/- 2.4%, p < 0.05). AP patients had more significant decrease of taurocholic acid--to 4.5 +/- 0.7% (control--9.2 +/- 0.7%, p < 0.05). In the peripheral blood of AP patients there was an elevated basal level of serotonin and acetylcholine in the presence of low cholinesterase activity. After meal, acetylcholine concentration lowered in high secretion of serotonin.. Depending on severity of destructive changes in the pancreas, AP and BP patients had different degree of exocrine insufficiency which may be secondary to the absence of acetylcholine rise in the blood after meal. Alterations in the composition of the conjugates of cholic and taurodioxicholanic BA lead to alterations of CCK blood concentration and, therefore, to changes in exocrine pancreatic secretion. Imbalance between serotonin and acetylcholine levels after meal evidences for defects in conventional regulatory interrelations. Decreased threshold of nociceptors activation in simultaneous enhancement of afferent nociceptive flows may entail pain syndrome in CP.

Topics: Acetylcholine; Adult; Aged; Cholecystokinin; Chronic Disease; Exocrine Glands; Female; Humans; Male; Middle Aged; Pancreatitis; Serotonin; Taurodeoxycholic Acid

Black Tea Extract (BTE), a phytocompound has been attributed with a plethora of health-promoting actions. We have previously demonstrated that BTE inhibits chronic hepatitis in a rat model induced with high-fat and ethanol (EtOH). This study reports that BTE prevents altered pancreatic acinar cell functions, oxidative stress, inflammatory changes and DNA damage in the EtOH+cholecystokinin (CCK)-induced model of pancreatitis. The EtOH+CCK model rats were administered with BTE, and were examined the activity of pancreatic digestive enzymes (amylase and lipase), proinflammatory cytokines (IL-6 and TNF-alpha), oxidative and antioxidative enzymes (nitric oxide, NO; malondialdehyde, MDA; superoxide dismutase, SOD; catalase, CAT), antioxidant level (glutathione, GSH), histopathological changes and the integrity of genomic DNA. Results show that because of chronic EtOH treatment, serum level of amylase and lipase (two biomarkers for pancreatitis) and pancreatic levels of MDA and NO (two biomarkers of oxidative stress) increased significantly, which could be effectively blunted by BTE. BTE could normalize EtOH+CCK-induced suppressed activities of SOD and CAT, and GSH content of pancreatic tissue. Also, histopathological and inflammatory changes during EtOH+CCK-induced pancreatitis could be blunted by BTE. Furthermore, BTE could effectively reduce EtOH+CCK-induced increase in DNA fragmentation and damage. These findings suggest that BTE prevents pancreatitis caused by chronic EtOH+CCK toxicity presumably by enhancing antioxidant, anti-inflammatory and antiapoptotic activity in rats.

Topics: Amylases; Animals; Antioxidants; Camellia sinensis; Cholecystokinin; Chronic Disease; Cytokines; Disease Models, Animal; Ethanol; Glutathione; Lipase; Lipid Peroxidation; Male; Pancreas; Pancreatitis; Plant Leaves; Rats; Tea

Chronic constipation caused by slow transit is common in women with an F/M ratio of 9:1. The cause and mechanisms responsible for this syndrome are unknown. Progesterone has been suggested as a possible contributing factor. Our aim was to investigate the site and mechanisms responsible for this colonic motility disorder.. Seven women with intractable constipation and slow transit time underwent colectomy and 6 women who underwent a left colectomy for adenocarcinoma (controls) were studied. Dissociated colonic circular muscle cells were obtained by enzymatic digestion. Changes in G-protein levels were measured by Western blot. The messenger RNA (mRNA) expression of Galpha q and progesterone receptors was determined by reverse-transcription polymerase chain reaction and Northern blot.. Muscle cells from patients with chronic constipation exhibited impaired contraction in response to receptor-G-protein-dependent agonists (cholecystokinin [CCK], acetylcholine) and in response to the direct G-protein activator guanosine 5'-O-(3-thiophosphate). Contraction was normal with receptor-G-protein-independent agonists (diacylglycerol and KCl). Western blot showed down-regulation of Galpha q/11 and up-regulation of Galpha s proteins in patients with chronic constipation. The mRNA expression of Galpha q was lower and the progesterone receptors were overexpressed in patients with chronic constipation compared with controls. These abnormalities were reproduced in vitro by pretreatment of normal colonic muscle cells with progesterone for 4 hours.. Slow transit chronic constipation in women may be caused by down-regulation of contractile G proteins and up-regulation of inhibitory G proteins, probably caused by overexpression of progesterone receptors.

Topics: Acetylcholine; Animals; Case-Control Studies; Cholecystokinin; Chronic Disease; Colon; Constipation; Female; Gastrointestinal Motility; Gastrointestinal Transit; GTP-Binding Proteins; Guanosine 5'-O-(3-Thiotriphosphate); Guinea Pigs; Humans; Myocytes, Smooth Muscle; Pregnancy; Progesterone; Receptors, Progesterone; RNA, Messenger; Signal Transduction

The goal of this study was to examine the severity of exocrinous and endocrinous pancreatic incompetence, composition of bile acids (BA) and hemostasis state depending on the etiologic form of chronic pancreatitis (CP). The study comprised 76 patients with CP at the age of 33-74 (46 females and 30 males), 20 of them having alcoholic pancreatitis (AP), 26 --biliary pancreatitis (BP), and 30--involutional pancreatitis (IP); 15 people (without any signs of gastrointestinal tract lesions) made up the control group. CP was diagnosed based on clinical data, laboratory and instrumental assessments. Various degrees of severity of exocrinous and endocrinous pancreatic incompetence were revealed depending on the CP etiology. AP patients had more marked alterations of this type depending on the severity and presence of complications. The study revealed changes in the quantitative and qualitative BA composition, which can cause reduced absorption of exogenous cholesterol in the CP patients' bowels and be one of the reasons affecting the exocrinous function of the pancreas. IP patients had more marked alterations of this type. All CP patients had blood hypercoagulation accompanied by a reduction of the public constant of blood coagulation, increase of the coagulation index and clot elasticity. Patients with the complicated course of the disease had more marked alteration of this type.

Topics: Adult; Aged; Bile Acids and Salts; C-Peptide; Cholecystokinin; Chronic Disease; Feces; Female; Homeostasis; Humans; Male; Middle Aged; Pancreas; Pancreatic Elastase; Pancreatic Function Tests; Pancreatitis

The aims of this study were: 1) to obtain an experimental model reproducing the characteristics of chronicity and spontaneous relapses found in inflammatory bowel disease (IBD) and 2) to correlate these changes with intestinal motility and bacteria translocation. For this purpose, two groups of Sprague-Dawley rats were used: a treated group that received two subcutaneous injections of indomethacin (7.5 mg/kg) 48 h apart and a control group that received saline. Blood leukocytes, TNF, and fecal parameters were monitored for 90 days after treatment. In treated rats, a cyclic oscillation of blood leukocytes and TNF concomitant with an inverse correlation of fecal output was observed. Treated rats were then selected either during their highest or lowest blood leukocyte values for motor activity and microbiological evaluation. Controls were obtained in age-matched rats. Rats with high leukocyte levels showed a decrease of motor activity. In contrast, animals with low leukocyte levels presented hypermotility. Bacterial overgrowth accompanied by bacterial translocation was found in the group with high leukocytes, whereas no differences were observed between the control and indomethacin groups during the lowest leukocyte phase. We obtained a model of IBD characterized by a chronic cyclic oscillation of intestinal motility, flora, and inflammatory blood parameters. During the high-leukocyte stage, motor activity decrease is related to bacterial translocation. This phase is followed by a reactive one characterized by hypermotility associated with a decrease in both bacterial growth and leukocytes. However, as in IBD, this reaction seems unable to prevent a return to relapse.

Topics: Acute Disease; Animals; Anti-Inflammatory Agents, Non-Steroidal; Bacteria; Bacterial Infections; Bacterial Translocation; Cholecystokinin; Chronic Disease; Enteritis; Enzyme Inhibitors; Gastrointestinal Motility; Indomethacin; Injections, Subcutaneous; Intestinal Diseases; Leukocyte Count; Male; Nitroarginine; Rats; Rats, Sprague-Dawley; Tumor Necrosis Factor-alpha

Chronic pancreatitis should be considered in all patients with unexplained abdominal pain. Management of abdominal pain in these patients continues to pose a formidable challenge. The importance of small duct disease without radiographic abnormalities is now a well-established concept. It is meaningful to determine whether patients with chronic pancreatitis have small duct or large duct disease because this distinction has therapeutic implications. Diagnostic evaluation should begin with simple noninvasive and inexpensive tests like serum trypsinogen and fecal elastase, to be followed where appropriate by more complicated measures such as the secretin hormone stimulation test, especially in patients with suspected small duct disease. No universal causal treatment is available. Non-enteric-coated enzyme preparations are useful for treatment of pain, whereas enteric-coated enzyme preparations are preferred for steatorrhea. Octreotide is used increasingly for abdominal pain that is unresponsive to pancreatic enzyme therapy. When medical therapy for chronic pancreatitis pain has failed, endoscopic therapy, endoscopic ultrasound-guided celiac plexus block, and thoracoscopic splanchnicectomy, performed by experts, may be considered for a highly selected patient population. Surgical ductal decompression is appropriate in patients with considerable pancreatic ductal dilation. The role and efficacy of cholecystokinin-receptor antagonists, antioxidants, and antidepressant drugs remain to be defined.

Topics: Abdominal Pain; Cholecystokinin; Chronic Disease; Devazepide; Endosonography; Gastrointestinal Agents; Gastroparesis; Hormone Antagonists; Humans; Octreotide; Pancreatic Function Tests; Pancreatitis

Pain in patients with chronic pancreatitis is difficult to manage. We examined if an enteral formulation containing medium-chain triglycerides (MCT) and hydrolyzed peptides would (1) minimally stimulate the exocrine pancreas by blunting cholecystokinin release and (2) decrease pain in patients with chronic pancreatitis.. In the first part of the study, on separate days, 6 healthy controls consumed a standard enteral formulation, an enteral formulation containing MCT and hydrolyzed peptides, and a high-fat meal. Baseline and postprandial plasma cholecystokinin (CCK) concentrations were analyzed. Subsequently, 8 patients with chronic pancreatitis were enrolled and instructed to complete a visual analog pain assessment for a baseline period of 2 weeks followed by three cans per day of the enteral formulation containing MCT and hydrolyzed peptides for 10 weeks.. Mean CCK levels for our control subjects were 0.46 +/- 0.29 pM at baseline, 10.75 +/- 0.45 pM in response to the high-fat meal, and 7.9 +/- 1.25 pM in response to the standard enteral formulation. Of note, CCK levels were 1.43 +/- 0.72 pM in response to the enteral supplement containing MCT and hydrolyzed peptides. In patients with chronic pancreatitis, the average improvement in pain scores from baseline to the conclusion of the study was 61.8% (p = 0.01). This corresponded to a clinical improvement in 6 of the 8 patients.. A complete enteral supplement containing MCT and hydrolyzed peptides minimally increases plasma CCK levels. This therapy may be effective in reducing postprandial pain associated with chronic pancreatitis.

Topics: Adult; Aged; Case-Control Studies; Cholecystokinin; Chronic Disease; Enteral Nutrition; Humans; Hydrolysis; Middle Aged; Pain; Pancreatitis; Peptides; Postprandial Period; Triglycerides

The authors improved the probe assay of the pancreas: an original euphylline-calcium test was developed. The examination is informative and safe in the diagnostics of the chronic relapsing pancreatitis. A number of advantages of the optimized method of diagnostics before the traditional ones, including the secretin-pancreazimin test, were proven.

Topics: Aminophylline; Calcium Gluconate; Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatitis; Recurrence; Secretin

The cholecystokinin (CCK)/secretin pancreatic function tests to diagnose pancreatic exocrine insufficiency are time consuming and invasive. Our aim was to develop a rapid pancreatic function test performed during upper endoscopy that could discriminate between patients with normal from impaired exocrine pancreatic secretion.. We prospectively evaluated 412 patients for possible pancreatic diseases. During upper endoscopy, 1 CU/kg of secretin was given intravenously and duodenal juice (collected for 10 min) was assayed for concentrations of bicarbonate and lipolytic and trypsin activity. Final diagnosis was by histology, imaging, and a previously validated scoring system (for chronic pancreatitis). Of 412 patients, 117 patients had normal pancreas, 72 patients had chronic pancreatitis, and 116 patients had pancreatic adenocarcinoma. The remaining 107 patients had miscellaneous disease of the peripancreatic region. In 28 patients we also validated the secretin test with the standard CCK pancreatic function test.. There was no difference between bicarbonate or trypsin concentrations among the groups. Lipolytic concentration was significantly lower in chronic pancreatitis (115 +/- 18) and in pancreatic adenocarcinoma (87 +/- 10) compared with patients with normal pancreas (229 +/- 23; P < 0.03 and P < 0.0001, respectively). The overall accuracy of the endoscopic secretin test was 79%, with positive and negative predictive values of 73% and 85%, respectively. The concentration of lipolytic activity obtained by the endoscopic secretin test in 28 patients correlated moderately well (r = 0.41, P < 0.03) with lipolytic output obtained by the CCK pancreatic function test.. Lipolytic concentration in duodenal juice after intravenous secretin collected for 10 minutes during upper endoscopy was significantly lower in chronic pancreatitis and pancreatic adenocarcinoma compared with patients with normal pancreas, but was not accurate enough for routine clinical use.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Aged, 80 and over; Bicarbonates; Cholecystokinin; Chronic Disease; Diagnosis, Differential; Endoscopy, Gastrointestinal; Female; Humans; Lipase; Male; Middle Aged; Pancreatic Function Tests; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin; Sensitivity and Specificity; Trypsin

Patients with symptoms consistent with biliary colic who do not demonstrate calculi on routine sonography present a diagnostic dilemma for clinicians. For those patients in whom other disease entities have been excluded and in whom the history and physical examination exemplify classic signs and symptoms of biliary disease we show in this study that cholecystokinin cholescintigraphy with calculation of gallbladder ejection fraction is a predictor of pathology as well as subsequent symptom relief after cholecystectomy. The spectrum of pathology that makes up chronic acalculous biliary disease lacks a distinct definition, yet this review shows that cholecystokinin cholescintigraphy offers the surgeon the means to better counsel his or her patient with regard to surgical indications, options, and benefits. We reviewed 26 patients who had no gallstones detectable, had gallbladder ejection fraction <35 per cent, and were status postlaparoscopic cholecystectomy for suspected chronic acalculous biliary disease. Our results show histopathologic evidence of chronic cholecystitis in 100 per cent, and 92 per cent of the patients had improvement of symptoms and satisfaction with the operation to the point that they would undergo the surgery again without reservation.

Topics: Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystokinin; Chronic Disease; Humans; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Treatment Outcome

Hormonal stimulation with secretin or cholecystokinin (CCK) is the most sensitive means of assessing pancreatic function. Secretin is not available, and current CCK tests are cumbersome, requiring dual tube intubation and marker perfusion techniques. The aim of this study was to test the efficacy of a new CCK-stimulated pancreatic function test measuring peak lipase concentration.. A Dreiling gastroduodenal tube was inserted to the ligament of Treitz, and fluid was collected on ice for 80 min in four 20-min aliquots. CCK was infused i.v. at a constant rate of 40 ng/kg/h. Gastric aspirations were discarded. Duodenal aspirates were analyzed for volume and enzyme concentration with a clinical laboratory autoanalyzer.. Nineteen healthy volunteers and 18 chronic pancreatitis patients were studied. Lipase concentration and secretory volume showed a peak response by 40 min of stimulation, whereas amylase response was variable. The mean peak lipase concentrations (+/-SEM) for normal volunteers and mild, moderate, and advanced chronic pancreatitis patients were 16.9+/-1.9, 7.9+/-1.7, 3.7+/-1.2, and 2.1+/-0.6 x 10 5 IU/L, respectively. Lower peak lipase concentrations were significantly associated with more advanced chronic pancreatitis (p < 0.001). The receiver operating characteristic curve area for all chronic pancreatitis patients was 0.944 (95% CI = 0.825-0.985). A peak lipase concentration of 780,000 IU/L provided a sensitivity and specificity of 0.833 and 0.867, respectively. This CCK test was well tolerated and without complications.. Lipase concentration in duodenal fluid increases nearly 3-fold from baseline after CCK stimulation in healthy volunteers but is markedly reduced in patients with chronic pancreatic disease. Peak lipase concentration is a significant predictor of chronic pancreatitis and correlates with severity of pancreatic disease. Aspiration of duodenal drainage fluid with a Dreiling tube and analysis with a laboratory autoanalyzer are less cumbersome than marker perfusion and back titration techniques. Measurement of enzyme concentration instead of output could lead to the development of an endoscopic or through-the-scope screening method for assessing patients with suspected chronic pancreatitis or chronic abdominal pain.

Topics: Adult; Body Fluids; Cholecystokinin; Chronic Disease; Drainage; Duodenum; Female; Humans; Intubation, Gastrointestinal; Lipase; Male; Middle Aged; Osmolar Concentration; Pancreas; Pancreatitis; Reference Values; ROC Curve; Specimen Handling

Topics: Abdominal Pain; Algorithms; Carrier Proteins; Cholecystokinin; Chronic Disease; Enzyme Therapy; Feedback; Growth Substances; Humans; Intercellular Signaling Peptides and Proteins; Pancreas; Pancreatitis; Trypsin Inhibitor, Kazal Pancreatic

In patients with chronic pancreatitis (CP) the relation among exocrine pancreatic secretion, gastrointestinal hormone release, and motility is disturbed. We studied digestive and interdigestive antroduodenal motility and postprandial gut hormone release in 26 patients with CP. Fifteen of these patients had pancreatic insufficiency (PI) established by urinary para-aminobenzoic acid test and fecal fat excretion. Antroduodenal motility was recorded after ingestion of a mixed liquid meal. The effect of pancreatic enzyme supplementation was studied in 8 of the 15 CP patients with PI. The duration of the postprandial antroduodenal motor pattern was significantly (P < 0.01) prolonged in CP patients (324 +/- 20 min) compared with controls (215 +/- 19 min). Antral motility indexes in the first hour after meal ingestion were significantly reduced in CP patients. The interdigestive migrating motor complex cycle length was significantly (P < 0.01) shorter in CP patients (90 +/- 8 min) compared with controls (129 +/- 8 min). These abnormalities were more pronounced in CP patients with exocrine PI. After supplementation of pancreatic enzymes, these alterations in motility reverted toward normal. Digestive and interdigestive antroduodenal motility are abnormal in patients with CP but significantly different from controls only in those with exocrine PI. These abnormalities in antroduodenal motility in CP are related to maldigestion.

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Diabetes Mellitus, Type 1; Digestion; Duodenum; Eating; Enzymes; Female; Gastrointestinal Motility; Humans; Islets of Langerhans; Male; Middle Aged; Pancreas; Pancreatic Polypeptide; Pancreatitis; Peptide YY

Topics: Adult; Analgesia; Cholecystokinin; Chronic Disease; Humans; Male; Pancreas; Pancreatitis; Proglumide

Topics: Adult; Cholecystitis; Cholecystokinin; Chronic Disease; Female; Gallbladder; Humans; Radionuclide Imaging

Impaired gallbladder emptying has been identified as a cause of chronic abdominal pain in adults. This study aims to define a pediatric population with functional abnormalities of gallbladder contractility and to assess clinical outcome after cholecystectomy.. Children and adolescents (n = 42) with abdominal complaints underwent gallbladder emptying studies, measured by either ultrasonography or scintigraphy with intravenous cholecystokinin (CCK). On ultrasound studies, gallbladder volume was measured before injection and 15 minutes after injection. Measures of gallbladder emptying by scintigraphy were taken at least 30 minutes after CCK injection. A study was classified as abnormal for contractility less than 50%. Cholecystectomy was performed and outcomes were evaluated during office visits and by telephone interview.. Abdominal pain and fatty food intolerance were the predominant symptoms. Patients were treated by open (n = 2) or laparoscopic (n = 40) cholecystectomy. In 20 cases the gallbladder showed chronic inflammation on pathology. Response to surgical therapy was excellent in 41 patients (mean follow-up, 20.4 months).. Children and adolescents with persistent abdominal pain should undergo functional assessment of gallbladder contractility. Patients with abnormal gallbladder contractility benefit from cholecystectomy.

Topics: Abdominal Pain; Adolescent; Child; Cholecystokinin; Chronic Disease; Female; Gallbladder; Gallbladder Diseases; Gallbladder Emptying; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Diethyl-iminodiacetic Acid

Topics: Abdominal Pain; Bile Acids and Salts; Cholecystokinin; Chronic Disease; Duodenum; Eating; Humans; Osmolar Concentration; Pain; Pancreatitis; Prospective Studies

Patients with chronic pancreatitis and exocrine insufficiency have lower intraduodenal pH compared to controls. It has been assumed that abnormal low intraduodenal pH in these patients not only results from impaired pancreatic bicarbonate secretion but also from an increased gastric acid load to the duodenum.. We have tested this hypothesis by combined intragastric and intraduodenal 24 h pH monitoring in nine chronic pancreatitis patients with exocrine pancreatic insufficiency and nine healthy control subjects during standardized test conditions. Postprandial gastrin and cholecystokinin release were also determined.. Median 24-h intraduodenal pH (5.90 vs. 6.00) and intragastric pH (1.60 vs. 1.70) were not significantly different between patients and controls. However, in the 2-h postprandial periods intraduodenal pH was below five for a significantly higher percentage of time in chronic pancreatitis patients compared to controls (lunch: 14.5% vs. 0.17%, P=0.011; dinner: 24.1% vs. 5.75%, P=0.05). The post-dinner intragastric pH was below three for a significantly higher percentage of time in chronic pancreatitis patients vs. controls (72.2 vs. 48.9%, P=0.04). Postprandial gastrin release was not significantly different between the two groups. Postprandial secretion of cholecystokinin (CCK), as enterogastrone, was significantly (P < 0.01) reduced in chronic pancreatitis patients (78 +/- 13 pmol/L, 120 min) compared to controls (155 +/- 14 pmol/L, 120 min).. Median intraduodenal and intragastric pH are not significantly decreased in patients with chronic pancreatitis and exocrine insufficiency but the postprandial time with an acidic pH in the duodenum (pH < 5) and in the stomach (pH < 3) is significantly (P

Topics: Adult; Case-Control Studies; Cholecystokinin; Chronic Disease; Duodenum; Exocrine Pancreatic Insufficiency; Female; Gastric Mucosa; Gastrins; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Pancreatitis; Postprandial Period; Time Factors

Cholecystokinin (CCK) secretion may be affected in patients with chronic pancreatitis (CP), but little is known on the effect of pancreatic surgery on CCK secretion. We measured CCK secretion (radioimmunoassay, RIA) in response to bombesin infusion (100 ng/kg/20 min) for 120 min to test CCK secretory capacity, to ingestion of a liquid diet (400 kcal) for 120 min, and in response to a solid fat-rich meal (500 kcal) for 120 min. These studies were performed in 45 patients with CP (25 with exocrine insufficiency), 15 patients after duodenum-preserving pancreatic head resection (DPRHP), 18 patients after the Whipple operation, 12 patients after distal pancreatectomy (DP), and 35 control subjects. In CP patients, the CCK secretory capacity was preserved, but the postprandial CCK response was reduced, depending on meal composition and the presence of exocrine insufficiency. In patients after Whipple's operation, CCK secretory capacity and postprandial CCK secretion were significantly (p < 0.05) reduced. In patients after DPRHP, CCK secretory capacity was not affected, but the postprandial CCK response was significantly (p < 0.05) reduced, depending on meal composition and the presence of exocrine insufficiency. In patients after DPRHP, fasting plasma CCK levels were significantly (p < 0.01) increased, pointing to the absence of feedback inhibition on CCK secretion by intraluminal enzymes. After DP, the CCK secretory capacity was not affected.. alterations in CCK secretion are observed in patients with chronic pancreatitis and after pancreatic surgery. These alterations are related not only to the disease process (exocrine insufficiency) but also to the type of surgery and type of stimulus.

Topics: Adult; Bombesin; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy; Cholecystokinin; Chronic Disease; Digestive System Surgical Procedures; Duodenum; Eating; Female; Gastrectomy; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Pancreatitis; Postprandial Period; Reference Values

Numerous publications have reported that a low gallbladder ejection fraction (GBEF) determined by cholecystokinin (CCK) cholescintigraphy has a high positive predictive value for the diagnosis of chronic acalculous cholecystitis (CAC). Clinicians and surgeons have found this test to be clinically useful as an objective method to confirm their clinical diagnosis. However, an abnormally low GBEF is not specific for CAC. For example, numerous other diseases have been associated with a low GBEF, and various therapeutic drugs can cause poor gallbladder contraction. Importantly, improper CCK infusion methodology can result in an erroneously low GBEF. More than one third of healthy subjects and patients who receive sincalide, 0.02 microg/kg infused over 1-3 min, will have an erroneously low GBEF but will have a normal GBEF with a slower infusion (30-60 min) of the same total dose. Because of enthusiastic acceptance of CCK cholescintigraphy by clinicians, the types of patients referred for this test have changed over time. Patients investigated in publications confirming the usefulness of CCK cholescintigraphy had a high pretest likelihood of disease. They underwent extensive workup to rule out other diseases and were followed up for months or years before CCK cholescintigraphy was performed, allowing other diseases to become manifest or symptoms to resolve. However, CCK cholescintigraphy is now being used by clinicians to shorten the workup and follow-up time based on the rationale that CCK cholescintigraphy can quickly confirm or exclude the diagnosis. This new group of referral patients has a lower likelihood of the disease. Many will ultimately be diagnosed with diseases other than CAC. The positive predictive value of this test will likely be lower and the false-positive rate will likely be higher. Nuclear medicine physicians must work to minimize false-positive studies to maintain the confidence of referring clinicians. First, we can educate referring physicians as to the proper use of this study. Next, we must perform CCK cholescintigraphy using optimal methodology that will result in the lowest possible false-positive rate. And finally, we must interpret CCK cholescintigraphy in light of the patient's history, prior workup and clinical setting.

Topics: Cholecystitis; Cholecystokinin; Chronic Disease; False Positive Reactions; Female; Gallbladder; Gallbladder Emptying; Humans; Male; Radionuclide Imaging; Sincalide

Cholecystokinin (CCK) response to a test meal should be increased in patients with pancreatic insufficiency, as trypsin is absent from the duodenum. If pancreatic enzymes are added, a restoration of the inhibitory feedback should result in lower levels of CCK. Ten patients with chronic pancreatitis and steatorrhea were studied. CCK basal and postprandial levels were evaluated the day before and 45 and 90 days after treatment with oral pancreatin. Twelve healthy volunteers were included as reference group. CCK basal levels did not vary. CCK response to a test meal was increased in patients before treatment and diminished when oral enzymes were maintained for months even after three days of therapy withdrawal. We conclude that long-term therapy with oral enzymes induces changes in CCK response that do not regress after three days of treatment suspension.

Topics: Adult; Case-Control Studies; Celiac Disease; Cholecystokinin; Chronic Disease; Female; Food; Gastrointestinal Agents; Humans; Male; Pancreatin; Pancreatitis; Postprandial Period; Time Factors

Cholelithiasis is a common disorder occurring in over 20 million people in the United States and resulting in approximately 600,000 cholecystectomies annually. Although over 95% of biliary tract disease is caused by gallstones, the vast majority (>80%) of cholelithiasis cases are asymptomatic. The purpose of this study is to evaluate the utility of quantitative cholescintigraphy in detecting symptomatic biliary tract disease and predicting clinical relief after cholecystectomy.. Fifty-two patients with clinical symptoms of chronic cholecystitis were evaluated by cholescintigraphy with a gallbladder ejection fraction calculated after the intravenous administration of cholecystokinin. A gallbladder ejection fraction of > or =35% was considered a normal physiologic response. Forty-one of the patients subsequently underwent cholecystectomy, whereas the remaining 11 subjects were diagnosed and treated for non-biliary disorders that did not require cholecystectomies. After clinical follow-up including histopathological gallbladder findings, all subjects' final diagnoses were established and correlated with their quantitative cholescintigram study.. Twenty-six of twenty-eight patients who had an abnormal quantitative cholescintigram demonstrated evidence of chronic cholecystitis by histopathologic criteria after cholecystectomy. Furthermore, 27 of these 28 patients (96%) experienced complete relief of their clinical symptoms after surgery.. Functional cholescintigraphy is a safe, accurate, and useful test for detecting symptomatic gallbladder disease, and appears reliable in predicting symptomatic relief after cholecystectomy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cholecystectomy; Cholecystitis; Cholecystokinin; Cholelithiasis; Chronic Disease; Female; Follow-Up Studies; Forecasting; Gallbladder; Gastrointestinal Agents; Humans; Injections, Intravenous; Male; Middle Aged; Muscle Contraction; Predictive Value of Tests; Radionuclide Imaging; Remission Induction; Reproducibility of Results; Safety; Sensitivity and Specificity

We compared pancreatic exocrine secretion in 5-month-old WBN/Kob rats, a model of chronic pancreatitis, with that in Wistar rats of the same age in a conscious state. Basal pancreatic secretion and pancreatic wet weight in WBN/Kob rats were lower than the values for Wistar rats. There was no difference in plasma cholecystokinin (CCK) concentration between the two types of rats. When CCK-8 was intravenously administered, the stimulation of pancreatic protein secretion in WBN/Kob rats was weaker than that in Wistar rats. When bile and pancreatic juice were diverted from the duodenum, the resulting increase in the plasma CCK concentration was similar in both types of rats, but stimulation of the volume and protein output of pancreatic juice in WBN/Kob rats was weaker than that in Wistar rats. In addition, WBN/Kob rats exhibited little increase in pancreatic wet weight because of this diversion. When secretin was intravenously administered, the stimulation of fluid secretion in WBN/ Kob rats was also weaker than that in Wistar rats. The binding of CCK-8 to pancreatic membrane fractions in WBN/Kob rats was much weaker than that in Wistar rats. Histological findings in WBN/Kob rat pancreas showed proliferation of fibrous tissue and atrophy of acinar cells. In conclusion, pancreatic exocrine secretion in response to the gastrointestinal hormones, CCK and secretin, was lower in WBN/Kob rats than in Wistar rats. These findings suggest that the hyposecretion of pancreas in WBN/Kob rats is hyporeaction of pancreatic membrane to gastrointestinal hormones.

Topics: Animals; Bile; Cholecystokinin; Chronic Disease; Disease Models, Animal; Male; Pancreas; Pancreatic Juice; Pancreatitis; Proteins; Rats; Rats, Wistar; Secretin; Sincalide

Cholecystokinin (CCK) levels were measured in cerebrospinal fluid (CSF) of patients with adult chronic hydrocephalus syndrome (ACHS) (n = 16) and compared with levels from a control group (n = 11). The CSF concentration of CCK in the ACHS group (0.79 +/- 0.53 fmol/mL) was significantly reduced (p = .002) with respect to the controls (1.55 +/- 0.54 fmol/mL). As CCK-8, the most prevalent from of CCK in the central nervous system, has been demonstrated to play a significant role in several physiological and behavioral actions, the reduced octapeptide values found in ACHS could be involved in the disturbances associated with this disorder. Continuous monitoring of intracranial pressure (ICP) demonstrated different ICP profiles in ACHS. We found that all patients with abnormal ICP records except one showed CCK values under the detection limit. Three of the 4 patients with normal ICP had CCK levels within the normal range. These preliminary studies could evidence that ICP alterations are responsible for part of the loss of brain neuropeptide levels in ACHS.

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Female; Humans; Hydrocephalus, Normal Pressure; Intracranial Pressure; Male; Middle Aged; Monitoring, Physiologic; Neurologic Examination; Reference Values; Sincalide

Oral administration of a protease inhibitor (camostat) induces pancreatic hypersecretion via hormonal and neural systems in humans. Camostat may also affect gallbladder motility via these systems. The aim of this study was to evaluate the effect of camostat on gallbladder function. Gallbladder emptying in response to caerulein administration and to egg yolk ingestion was examined ultrasonographically in 15 patients with mild chronic pancreatitis before and after 6 months of camostat treatment, and in 10 control subjects. The plasma cholecystokinin concentration after yolk ingestion was measured by radioimmunoassay. Fasting gallbladder volume and contractile function, whether stimulated by caerulein or yolk, did not differ between pancreatitis patients before camostat treatment and controls. Plasma cholecystokinin levels, basal and yolk-stimulated, did not differ between nontreated pancreatitis patients and control subjects. Fasting volume had decreased significantly by 1, 3, and 6 months of camostat treatment, while contractile function was not affected. Camostat did not influence plasma cholecystokinin levels. Oral administration of a protease inhibitor appears to decrease fasting gallbladder volume via a mechanism other than cholecystokinin release.

Topics: Administration, Oral; Adult; Aged; Cholecystokinin; Chronic Disease; Esters; Female; Gabexate; Gallbladder; Guanidines; Humans; Male; Middle Aged; Pancreatitis; Protease Inhibitors

Postprandial gallbladder motility is regulated mainly by the hormone cholecystokinin (CCK). Since CCK secretion may be reduced in patients with pancreatic insufficiency (PI), we studied postprandial gallbladder motility in these patients.. Fifteen patients with PI due to chronic pancreatitis and 17 healthy control subjects were studied. Gallbladder volumes (ultrasonography) and plasma CCK concentrations (RIA) were determined at regular intervals for 120 min after meal ingestion. Urinary PABA and faecal fat excretion were measured to determine pancreatic exocrine function.. Patients with PI had larger fasting gallbladder volumes than controls (48 +/- 6 cm3 versus 29 +/- 2 cm3; p < 0.01). Gallbladder ejection volume at time 120 min was not significantly different between patients with PI (14 +/- 4 cm3) and controls (20 +/- 2 cm3). However, the percentage postprandial gallbladder emptying in patients with PI was significantly reduced compared to controls (at 120 min: 29 +/- 8% versus 68 +/- 3%; p < 0.001). Residual postprandial gallbladder volume was increased in patients with PI compared to controls (at 120 min: 34 +/- 4 cm3 versus 9 +/- 1 cm3; p < 0.001). Postprandial endogenous CCK secretion was significantly reduced in patients with PI compared to controls (78 +/- 13 pM.120 min versus 155 +/- 14 pM.120 min; p < 0.001). Postprandial gallbladder emptying (%) was related to the degree of exocrine pancreatic insufficiency (r = 0.81; p < 0.001).. In patients with pancreatic insufficiency due to chronic pancreatitis: 1) fasting and residual postprandial gallbladder volumes are significantly increased; 2) postprandial CCK secretion and percentage gallbladder contraction are significantly reduced; 3) percentage postprandial gallbladder emptying is related to the degree of pancreatic exocrine insufficiency.

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Female; Gallbladder; Gastrointestinal Motility; Humans; Male; Middle Aged; Pancreas; Pancreatic Polypeptide; Pancreatitis

Duodenum-preserving resection of the head of the pancreas (DPRHP) is performed in patients with chronic pancreatitis (CP) localized in the head of the pancreas. It has been suggested that functional integrity of the upper digestive tract is preserved after DPRHP. We tested this hypothesis with regard to gallbladder motility.. Gallbladder motility and cholecystokinin (CCK) secretion were studied fasting, after cephalic vagal stimulation with sham feeding, and after regular feeding in 9 patients after DPRHP, in 6 unoperated patients with CP, and 9 healthy control subjects.. Mean fasting gallbladder volume in patients after DPRHP (49 +/- 10 cm3) and patients with CP (53 +/- 10 cm3) was larger than in controls (33 +/- 3 cm3). Sham-feeding gallbladder contraction did not differ between patients after DPRHP, patients with CP, and controls. Both postprandial CCK secretion and gallbladder contraction in patients after DPRHP (78 +/- 16 pM. 120 min; 47% +/- 6%) and patients with CP (72 +/- 18 pM.120 min; 40% +/- 7%) were significantly reduced (P < 0.05) compared with controls (151 +/- 13 pM.120 min; 74% +/- 4%). Fasting gallbladder volume, sham feeding, and regular-feeding-induced gallbladder contraction and postprandial CCK secretion did not differ between operated and unoperated patients with CP.. Gallbladder motility and CCK secretion are reduced in patients with pancreatic insufficiency. A DPRHP procedure does not further influence these results. These findings support the concept that gallbladder motor function is preserved after DPRHP.

Topics: Adult; Cholecystokinin; Chronic Disease; Duodenum; Exocrine Pancreatic Insufficiency; Fasting; Female; Gallbladder; Gallbladder Emptying; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Postprandial Period; Ultrasonography

Results of the SPT and the ERCP staged for their severity were compared in 202 patients. The correlation between both investigations was significant (p < 0.001); however, ERCP showed significantly more severe changes (p = 0.04). Furthermore, we found that 129 (64%) patients had parallel SPT and ERCP results, matching in all four gradings of severity. Forty-three (21%) patients had abnormal results for both SPT and ERCP, but the severity gradings did not parallel. Finally, 30 (15%) patients showed totally nonparallel results, a normal SPT and abnormal ERCP, or vice versa. Abnormal ERCP but normal SPT results were found in 23 of these 30 patients (group 1), and normal ERCP but abnormal SPT results in the seven remaining cases (group 2). In the first group, more patients had a history of acute pancreatitis compared to the second group (19 vs. one, p < 0.005). Based on medical history, laboratory and functional test results, and other morphological tests, chronic pancreatitis was diagnosed in two of 23 patients in group 1 and in all seven patients in group 2. Follow-up interviews (86 +/- 54 months) were possible in 20 of the remaining 21 patients in group 1 and showed definite chronic pancreatitis in one and probable chronic pancreatitis in another two of them, whereas in the other 17 patients no symptoms of acute pancreatitis or abdominal pain suggestive of chronic pancreatitis had occurred. In conclusion, both SPT and ERCP should be used to complement each other when chronic pancreatitis is suspected. ERCP seems to over-diagnose the disease since duct changes may only reflect scars after severe acute pancreatitis, or old age, and are not necessarily a sign of chronic pancreatitis. SPT seems to diagnose chronic pancreatitis with more reliability.

Topics: Adult; Aged; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatitis; Retrospective Studies; Secretin

The effect of oral administration of protease inhibitor (camostat) on pancreatic morphology and exocrine function (conscious rat model) was investigated using WBN/Kob rats with spontaneous chronic pancreatitis. In nontreated WBN/Kob rats (2-12 months of age), pancreatic fibrosis and parenchymal destruction compatible with human chronic pancreatitis appeared at 3 months and advanced with each month. Pancreatic secretion was markedly impaired at all ages. In WBN/Kob rats fed diets containing camostat (from 2-3 or 4-5 months of age), the pancreas was hypertrophic and did not show any histological appearances compatible with chronic pancreatitis, and moreover, exocrine function was thoroughly restored with increased plasma cholecystokinin concentrations. Oral administration of protease inhibitor has both preventive and therapeutic effects on pancreatic lesions and dysfunction in an animal model of chronic pancreatitis, probably via endogenous cholecystokinin release.

Topics: Administration, Oral; Animals; Cholecystokinin; Chronic Disease; Disease Models, Animal; Esters; Gabexate; Guanidines; Humans; Male; Pancreas; Pancreatitis; Protease Inhibitors; Rats; Rats, Inbred Strains; Rats, Wistar

Tiscornia and Dreiling (Physiopathogenic Hypothesis of Alcoholic Pancreatitis: Supranormal Ecbolic Stimulation of the "Pancreon" Units Secondary to the Loss of the Negative Component of Pancreas Innervation. Pancreas 1987;2:604-612.) proposed that hypertonicity of intrapancreatic cholinergic neurons provoked by chronic alcoholism may contribute to the pathogenesis of chronic pancreatitis (CP). In the present study, the validity of this hypothesis was investigated in humans by studying the effects of atropine, cisapride, and ethanol on the meal-stimulated secretion of pancreatic polypeptide (PP) and cholecystokinin (CCK) in healthy volunteers, heavy drinkers, and CP patients. In healthy volunteers, the early phase PP response (0-40 min) to a test meal was completely blocked by atropine, whereas it was augmented by cisapride, an enhancer of acetylcholine release from cholinergic nerves. The early phase PP response to a test meal was inhibited by ethanol in healthy volunteers, whereas, in heavy drinkers, the response was augmented and the inhibition by ethanol was abrogated. In CP patients, ethanol tended to enhance the early phase PP response. Ethanol did not affect the early phase CCK response to a test meal in any group, but it significantly enhanced the late phase CCK response (40-120 min) in CP patients. These results suggest that: (i) oral ethanol may inhibit the postprandial activation of the cholinergic neural pathway to the pancreas in healthy subjects, (ii) in heavy drinkers, postprandial cholinergic tone may be augmented and become resistant to the inhibition by ethanol, and (iii) the ethanol-induced increase in the postprandial CCK response in CP patients may play some role in the pathophysiology of this disease.

Topics: Adult; Alcoholism; Analysis of Variance; Atropine; Cholecystokinin; Chronic Disease; Cisapride; Ethanol; Humans; Male; Middle Aged; Pancreatic Polypeptide; Pancreatitis; Parasympathomimetics; Piperidines; Postprandial Period; Radioimmunoassay

Topics: Cholecystokinin; Chronic Disease; Endoscopy, Digestive System; Humans; Intubation, Gastrointestinal; Pancreas; Pancreatic Function Tests; Pancreatitis; Secretin

The study was conducted on five healthy subjects and six patients with calcifying pancreatitis (CP) and steatorrhea. Following overnight fasting, one tube each was placed in the stomach and the upper of the small intestine, respectively. Through the gastric tube, a test meal that included 30 g of fat (total calories, 625 kcal, 500 mL) was infused over a span of 30 min. Every 30 min (up to 150 min), fluid samples in the upper small intestine were collected and chilled, and the amylase, trypsin, and lipase levels were determined. In addition, in the case of the CP patients, a high-potency pancreatin preparation was infused into the stomach together with the test meal. In order to determine the plasma CCK level, blood sample were collected before test meal infusion and at 10, 20, 30, 45, 60, 90, 120, and 150 min subsequent to infusion. The plasma CCK was extracted using a Sep-Pak C-18 cartridge and analyzed with radioimmunoassay using an OAL-656 antibody. The result was converted to the CCK-8 level and expressed in pg/mL. The enzyme activities in the upper small intestine of the CP patients after test meal administration amounted to 22.8 (amylase), 10.8 (trypsin), and 16.9% (lipase) compared with the corresponding figures for the normal subjects. Following administration of a high-potency pancreatin in patients with CP, enzyme activities in the upper small intestine increased to 132.2 (amylase), 38.7 (trypsin), and 45.3% (lipase) compared with levels in the normal subjects. However, the healthy subjects and the CP patients, both with and without treatment with supplementary exogenous enzymes, all exhibited similar profiles in the plasma CCK response to stimuli. Based on these findings, we concluded that a negative feedback mechanism does not exist between the tryptic activity of the upper small intestine and the CCK secretory response in patients with chronic pancreatitis.

Topics: Adult; Amylases; Cholecystokinin; Chronic Disease; Exocrine Pancreatic Insufficiency; Feedback; Food; Humans; Intestine, Small; Lipase; Male; Middle Aged; Pancreatin; Pancreatitis; Trypsin

Somatostatin-, neuropeptide Y-, neurokinin B- and cholecystokinin-containing neurons were investigated in the rat hippocampus in two chronic models of temporal lobe epilepsy, i.e. 30 days after rapid kindling or electrically induced status epilepticus (post-status epilepticus). After rapid kindling, somatostatin immunoreactivity was strongly increased in interneurons and in the outer and middle molecular layer of the dentate gyrus. In four of six post-status epilepticus rats (status epilepticus I rats), somatostatin immunoreactivity was slightly increased in the dorsal but decreased in the ventral dentate gyrus and molecular layer. Somatostatin immunoreactivity decreased in neurons of the dorsal hilus in the two other post-status epilepticus rats investigated, while a complete loss was found in the respective ventral extension (status epilepticus-II rats). These changes were associated with a different extent of neurodegeneration as assessed by Nissl staining. Similarly, neuropeptide Y immunoreactivity was enhanced in neurons of the hilus and in the middle and outer molecular layer of the dentate gyrus in the dorsal hippocampus of rapidly kindled and status epilepticus-I rats. Neuropeptide Y and neurokinin B immunoreactivity was enhanced in the mossy fibers of all post-status epilepticus rats, but not in the rapidly kindled rats. In status epilepticus-II rats, neuropeptide Y-and neurokinin B-positive fibers were also detected in the infrapyramidal region of the stratum oriens of CA3 and in the inner molecular layer of the dentate gyrus in the dorsal and ventral hippocampus respectively, labeling presumably sprouted mossy fibers. Increased staining of neuropeptide Y and neurokinin B was found in the alveus after rapid kindling. Cholecystokinin immunoreactivity was markedly increased in the cerebral cortex, Ammon's horn and the molecular layer of the dentate gyrus in the ventral hippocampus of rapidly kindled and post-status epilepticus rats. The lasting changes in the immunoreactive pattern of various peptides in the hippocampus may reflect functional modifications in the corresponding peptide-containing neurons. These changes may be involved in chronic epileptogenesis, which evolves in response to limbic seizures.

Topics: Animals; Brain; Cholecystokinin; Chronic Disease; Epilepsy, Temporal Lobe; Immunohistochemistry; Male; Nerve Degeneration; Neurokinin B; Neuropeptide Y; Neuropeptides; Rats; Rats, Sprague-Dawley; Somatostatin; Tissue Distribution

Between April 1, 1989, and January 1, 1994, 38 patients with chronic acalculous cholecystitis underwent an advanced (3-puncture) laparoscopic cholecystectomy at our institution. The 30 women and 8 men had a mean age of 39 years (range, 23 to 65 years) and represented 4.5% of our overall gallbladder patient population. In each case, the disease produced typical biliary colic, but no gallstones were visualized on ultrasound examination; cholecystokinin-stimulated cholescintigraphy revealed a dysfunctional gallbladder, as evidenced by an ejection fraction of < or = 35% or nonvisualization or nonemptying of the organ. In all 38 cases, cholecystectomy resulted in the complete relief of symptoms. Although an increasing number of physicians are recommending this operation for acalculous gallbladder disease, it should not be performed on the basis of clinical history alone. Rather, objective criteria confirming the need for surgical intervention should be obtained by means of appropriate preoperative testing, including cholecystokinin-stimulated cholescintigraphy.

Topics: Adult; Aged; Biliary Dyskinesia; Cholecystectomy, Laparoscopic; Cholecystitis; Cholecystokinin; Chronic Disease; Female; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Technetium Tc 99m Lidofenin; Ultrasonography

Fecal bile acid and fecal fat were determined in 18 normal subjects and 22 patients with chronic pancreatitis, and the relation of fecal bile acid excretion to exocrine pancreatic dysfunction was studied. In chronic pancreatitis fecal bile acid was approximately three times that of control subjects, and large amounts of primary bile acid were detected. A significant correlation between fecal bile acid excretion and bicarbonate secreted from the pancreas was found. This evidence of bile acid malabsorption was not observed until bicarbonate output was < 0.05 mEq/h/kg. A slight correlation between fecal bile acid and absorption rates of fat was demonstrated. These results suggest that bile acid malabsorption observed in chronic pancreatitis is related to an impairment of pancreatic bicarbonate secretion.

Topics: Adult; Bile Acids and Salts; Cholecystokinin; Chronic Disease; Feces; Humans; Middle Aged; Pancreas; Pancreatitis; Secretin

The reduced decrease of plasma alpha-amino nitrogen after hormonal stimulation of the pancreas has been characterized as a valid and simple test of pancreatic function. Aim of this study was to reassess the clinical value of the alpha-amino nitrogen test and to evaluate the role of different modes of hormonal secretion. Therefore, we have investigated the relationship of plasma alpha-amino nitrogen responses and pancreatic secretion, stimulated by either bolus injection (n = 25) or continuous infusion (n = 32) of cholecystokinin-pancreozymin in patients with and without exocrine pancreatic insufficiency as determined by the secretin-pancreozymin test. Of the 57 patients referred to the secretin-pancreozymin-test, 18 had pancreatic insufficiency, each 9 in the group with continuous and bolus stimulation.. Basal alpha-amino nitrogen concentrations were almost identical in patients with and without impaired pancreatic function (2.66 +/- 0.12 mmol/l vs. 2.73 +/- 0.08 mmol/l [SEM]; p > 0.05). Both, the bolus dose and infusion of cholecystokinin induced similar (log-normally distributed) maximum decreases of alpha-amino nitrogen concentrations (-SD; mean; + SD: 3.6; 9.0; 22.3% vs. 6.0; 10.5; 18.5%, respectively) in the patients without exocrine pancreatic insufficiency. This was in tendency more pronounced compared to those with impaired pancreatic secretion (cholecystokinin bolus; 2.7; 5.2; 9.9%; infusion: 5.0; 7.7; 11.6%). The difference (+/- exocrine pancreatic insufficiency) was significant (p < 0.05) for the infusion mode only. Moreover, the time course of alpha-amino nitrogen concentration-profiles was more homogenous after hormone infusion as compared to bolus stimulation. Sensitivities to detect exocrine pancreatic insufficiency by the alpha-amino nitrogen test were < 50% with either test modification.. The decrease of plasma alpha-amino nitrogen after stimulation with cholecystokinin is no accurate indicator of exocrine pancreatic function, regardless of whether hormonal stimulation is by bolus or by infusion.

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Diabetes Mellitus; Exocrine Pancreatic Insufficiency; Humans; Infusions, Intravenous; Middle Aged; Pancreatic Function Tests; Pancreatic Juice; Pancreatitis; Reference Values; Secretin

Topics: Adult; Amino Acids; Cholecystokinin; Chronic Disease; Exocrine Pancreatic Insufficiency; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Predictive Value of Tests

We have recently developed a rat model of chronic pain states after spinal cord injury. Thus, after severe, but incomplete, ischemic spinal cord injury, some rats chronically exhibited responses indicative of pain to innocuous mechanical stimuli (allodynia) in the rostral dermatomes involving the injured spinal segments. These responses have some characteristics in common with chronic central pain in patients with spinal cord injury. We now report that systemic CI988, a specific antagonist of the cholecystokinin (CCK) type B receptor, effectively relieved the allodynia-like symptom, an effect that was reversed by the opioid receptor antagonist naloxone. Furthermore, in rats which did not develop the allodynia-like symptom after spinal cord lesion, systemic naloxone induced typical allodynia. In contrast, naloxone failed to produce allodynia in normal animals. It is thus suggested that the abnormal sensory processing initiated by spinal cord ischemic lesion is under tonic opioidergic control and dysfunction of this control by the upregulated endogenous CCK system is responsible for the development of painful sensations in these rats.

Topics: Animals; Anti-Anxiety Agents; Behavior, Animal; Cholecystokinin; Chronic Disease; Diazepam; Endorphins; Female; Indoles; Meglumine; Naloxone; Pain; Pain Measurement; Pain Threshold; Rats; Rats, Sprague-Dawley; Receptors, Cholecystokinin; Spinal Cord Injuries; Vocalization, Animal

The aim of this study was to investigate the relationship between postprandial release of cholecystokinin (CCK) and pancreatic polypeptide (PP) in healthy subjects and patients with chronic pancreatitis (CP). 14 patients with CP and 14 age-matched healthy subjects were studied. Diagnosis of CP was confirmed by standardized imaging modalities (ERCP and CT). Exocrine pancreatic function was assessed in all 28 subjects using the pancreolauryl serum test (PLT). An oral test meal was administered to stimulate endogenous hormone release. Plasma samples were taken before and at several time points after the test meal. CCK and PP plasma levels were measured by specific radioimmunoassays. Basal CCK and PP plasma levels were not different between patients with CP and controls, and were not correlated in either group. However, a direct linear correlation between integrated postprandial release of CCK and PP was found in healthy subjects (r = 0.74, P < 0.005). This postprandial coupling was not evident in patients with CP (r = 0.16; n.s.). Peak fluorescein serum concentration in patients with CP and steatorrhea (SCP) (n = 6) was < 2.5 micrograms/ml, and CCK and PP responses to the meal were significantly impaired (CCK response = 61 +/- 14 pmol/l/120 min in SCP vs. 110 +/- 14 in controls, P < 0.05; PP response = 3920 +/- 1773 pg/ml/120 min in SCP vs. 13418 +/- 3299 in controls, P < 0.05). In patients with mild/moderate exocrine insufficiency, CCK and PP responses varied greatly and were not different from controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Cholecystokinin; Chronic Disease; Eating; Female; Humans; Male; Middle Aged; Pancreatic Polypeptide; Pancreatitis; Radioimmunoassay

The present study was designed to analyze the underlying mechanism of gallbladder motor disturbance in chronic pancreatitis patients.. Gallbladder emptying to endogenous (oral test meal, Daiyan 13 g) and exogenous stimulation (iv cerulein, 30 ng/kg for 5 min) was examined by real-time ultrasonography in 12 patients with chronic pancreatitis and 10 normal subjects (controls). Plasma cholecystokinin levels during the endogenous stimulation were measured by bioassay.. In chronic pancreatitis patients compared with controls, the fasting gallbladder volume was significantly increased (29.5 +/- 2.2 vs. 21.5 +/- 2.8 ml), whereas the gallbladder emptying (percent change of the basal volume) to oral test meal was significantly decreased. Neither cholecystokinin secretion induced by the test meal, nor the gallbladder emptying response to intravenous cerulein, differed significantly between the two groups. However, when chronic pancreatitis patients were divided according to pathogenesis, it became clear that gallbladder emptying to intravenous cerulein was significantly greater in patients with alcoholic chronic pancreatitis than in patients with idiopathic pancreatitis.. Gallbladder emptying during the intestinal phase is generally reduced in patients with chronic pancreatitis, but gallbladder responsiveness to exogenous stimulation might be heterogeneous according to the pathogenesis.

Topics: Adult; Aged; Ceruletide; Cholecystokinin; Chronic Disease; Eating; Female; Gallbladder Emptying; Humans; Male; Middle Aged; Pancreatitis

Recent studies described an increased concentration of protein and calcium in association with a decreased concentration of citrate in pancreatic juice of patients suffering from chronic pancreatitis. These secretory changes may be of importance in the pathogenesis of chronic pancreatitis. The present study investigates pancreatic juices of 18 patients without pancreatic disease and 12 patients in an early phase of chronic pancreatitis in order to detect changes of the exocrine function of the pancreas in an early stage of the disease. In all persons the pancreatic juice was collected by endoscopic cannulation of the main pancreatic duct after i.v. stimulation with secretin and pancreozymin. The outputs and concentrations of protein, calcium and citrate were estimated. All of these parameters did not differ in control subjects and patients with chronic pancreatitis by univariate statistical analysis. However, a multivariate analysis detects differences in the biochemical composition of the secretions of controls and patients with chronic pancreatitis (efficiency of discrimination = 100%). Both in controls and in patients with chronic pancreatitis two calcium fractions were found after secretin stimulation: one secretory protein-associated fraction of 94 nmol calcium/mg protein and a protein-independent calcium fraction of 0.248 mmol/l, which diffuses paracellularly from the interstitium into the pancreatic juice. The results show that the secretory function of the exocrine pancreas is already disturbed in an early phase of chronic pancreatitis, whereas an increased lithogenity of the pancreatic juice cannot be detected.

Topics: Adult; Aged; Alcoholism; Calcium; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Citrates; Citric Acid; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Multivariate Analysis; Pancreatic Juice; Pancreatitis; Proteins; Reference Values; Secretory Rate

Cholecystokinin (CCK) has been shown to stimulate the growth of both normal pancreas and azaserine-induced putative preneoplastic pancreatic lesions in the rat. The present study was performed to determine whether these effects are mediated by way of CCK-A receptors, CCK-B receptors, or both. Sixteen-day-old male Lewis rats were given i.p. injections of azaserine at 30 mg/kg body weight. Starting on day 21, rats were given s.c. injections, 5 days/week for 16 consecutive weeks, of either (a) CCK octapeptide (nonselective CCK agonist) (2.50 micrograms/kg body weight, n = 17), (b) tert-butyloxycarbonyl-Trp-Lys(epsilon-N-2-methylphenylaminocarbonyl++ +)-Asp- (N-methyl)-Phe-NH2 (highly selective CCK-A agonist) (1.84 micrograms/kg body weight, n = 18), (c) [(2R,3S)-beta-MePhe28,N-MeNle31]CCK26-33 (highly selective CCK-B agonist) (2.40 micrograms/kg body weight, n = 18), or (d) normal saline solution (control, n = 17). Rats were subsequently sacrificed, pancreatic weights were determined, and quantitative morphometric analysis of atypical acinar cell foci and nodules was performed. Both CCK octapeptide and the selective CCK-A agonist tert-butyloxycarbonyl-Trp-Lys(epsilon-N-2- methylphenylaminocarbonyl)-Asp-(N-methyl)-Phe-NH2 stimulated pancreatic growth and the development of acidophilic atypical acinar cell foci and nodules. Furthermore, the effect produced by the selective CCK-A agonist tert-butyloxycarbonyl-Trp-Lys(epsilon-N-2- methylphenylaminocarbonyl)-Asp-(N-methyl)-Phe-NH2 was greater than that produced by CCK octapeptide. In contrast, the selective CCK-B agonist [(2R,3S)-beta-MePhe28,N-MeNle31]CCK26-33 had no effect. These findings suggest that the growth of putative preneoplastic lesions (acidophilic atypical acinar cell foci and nodules) in the rat pancreas during the early stages of azaserine-induced pancreatic carcinogenesis is mediated specifically by way of CCK-A receptors.

Topics: Animals; Azaserine; Cholecystokinin; Chronic Disease; Male; Organ Size; Pancreas; Pancreatic Neoplasms; Pancreatitis; Peptide Fragments; Precancerous Conditions; Rats; Rats, Inbred Lew; Receptors, Cholecystokinin; Sincalide; Tetragastrin

Gallbladder dynamics, cholecystokinin (CCK), and pancreatic polypeptide (PP) release were studied in 14 patients with chronic pancreatitis (CP) (2 females, 12 males; age range 24-56 years) and 12 control subjects (4 females, 8 males, 21-50 years). On day 1, gallbladder contractility was investigated after ceruletide intravenous infusion (2.5 ng/kg/min for 10 min). On day 2, a mixed standard test meal (1450 kJ) was administered orally. Gallbladder volume was assessed at three time intervals before (-30, -15, 0 min) and at 5, 10, 20, 30, 40, 50, 60, 80, 100 and 120 min after stimulation by means of ultrasonography. CCK and PP plasma levels were determined at each time interval. Exocrine pancreatic function was assessed using the pancreolauryl serum test (PLT). Six patients with CP had severe exocrine pancreatic insufficiency (EPI) (PLT < 1.8 micrograms/ml) with steatorrhea, eight patients had mild-moderate EPI. Fasting gallbladder volume was increased in CP (32.3 +/- 3.1 cm3) as compared to controls (20.5 +/- 1.2 cm3) (P < 0.01). Peak gallbladder contraction (percent of initial volume) in CP ranged from 5 to 55% (controls: 8-46%) following ceruletide and from 17 to 86% (controls: 27-80%) following the test meal (NS). There was no correlation between the degree of EPI according to PLT and peak gallbladder contraction. Gallbladder emptying in CP patients was not different from controls, although the postprandial CCK response was significantly impaired (P < 0.01). Postprandial PP response in CP was correlated with the PLT result (r = 0.78; P < 0.01) but not with gallbladder emptying or refilling time.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Alcoholism; Ceruletide; Cholecystokinin; Chronic Disease; Female; Food; Gallbladder; Gallbladder Emptying; Humans; Male; Middle Aged; Pancreas; Pancreatic Function Tests; Pancreatic Polypeptide; Pancreatitis; Radioimmunoassay

Methods of endogenous stimulation of the exocrinous pancreatic function in chronic primary gastroduodenitis were used. It was expressed in parallel gastric hyperchlorhydria, hyperproduction of pancreatic hydrocarbonates at initial stages of chronic primary gastroduodenitis and reduction of their excretion with diverse changes of the activity of pancreatic enzymes in prolonged and persistent course of the disease.

Topics: Cholecystokinin; Chronic Disease; Duodenitis; Gastritis; Humans; Pancreas; Recurrence; Secretin; Stimulation, Chemical

In patients with chronic pancreatitis (CP) (cholepancreatitis and primary recurrent pancreatitis), a moderate decrease of urocholecystokinin (UCK) excretion as a criterion for incretion of cholecystokinin-pancreozymin (CK) by duodenal endocrine cells was recorded in the presence of concomitant atrophic duodenitis. The beta-adrenoblocker obsidan, the blocker of m-cholinergic receptors gastrozepin, the antagonist of calcium channels finoptin and the synthetic analog of endogenous opiates dalargin reduced excretion of UCK in CP exacerbation. The decrease of CK incretion can be viewed as one of the mechanisms of the therapeutic action of these drugs in CP exacerbations. In the stage of CP remission, calcium gluconate consistently increased basal and intraduodenal oil (as a realizer of CK incretion) infusion-stimulated excretion of UCK. The enhancement of duodenal incretory activity is an essential mediating mechanism by which calcium gluconate stimulates pancreatic enzyme excretion.

Topics: Animals; Biological Assay; Cholecystokinin; Chronic Disease; Duodenum; Gallbladder; Guinea Pigs; Humans; Pancreatitis; Recurrence

To confirm correlation between function and histology of the exocrine pancreas in chronic pancreatitis, we compared exocrine pancreatic function, as estimated by cholecystokinin secretin test (CST), with histological findings in 108 patients. Exocrine pancreatic insufficiency was graded from 0 to 4 according to the number of abnormal CST parameters. Histological findings also were graded from 0 to 4. Results of CST in 108 patients were normal (grade 0) in 52, equivocal (grade 1) in 23, and abnormal (grades 2-4) in 33. Normal histological findings (grade 0) were observed in 54 patients, equivocal (grade 1) in 15, and abnormal (grades 2-4) in 39. We confirmed that there was a significant correlation between histological grading and overall scoring (tau = 0.59, p less than 0.01) or individual parameters (tau = -0.36 for volume, -0.45 for amylase output, and -0.54 for maximal bicarbonate concentration (p less than 0.01) of CST. Sensitivity of CST was 67% in 39 patients with histologically confirmed chronic pancreatitis, specificity was 90% in 69 patients without chronic pancreatitis, based on histological evidence, and efficiency was 81%. In conclusion, we confirmed a highly significant correlation between direct function test (CST) and histology of the exocrine pancreas.

Topics: Cholecystokinin; Chronic Disease; Female; Humans; Male; Pancreas; Pancreatitis; Secretin; Sensitivity and Specificity

The peptide hormones neurotensin (NT) and cholecystokinin (CCK) are commonly attributed with a physiological role in the stimulation of exocrine pancreatic secretion. However, on the other hand, little is known about the effect of diminished exocrine pancreatic function and of the resulting maldigestion on postprandial plasma levels of these two gastrointestinal peptides. We investigated, therefore, the effect of enzyme substitution therapy on the magnitude and time course of plasma concentrations of both hormones in patients suffering from severe chronic pancreatitis. Pancreatic insufficiency led to elevated NT-concentrations, in response to a standard meal, which could be reduced by enzyme replacement therapy. Prior to enzyme therapy, the mean integrated postprandial release of NT amounted to 2800 +/- 250 pg/ml after 60 min in patients with severe chronic pancreatitis. This amount was significantly reduced to 1250 +/- 150 pg/ml after 60 min after enzyme therapy, compared to 810 +/- 90 pg/ml after 60 min in healthy volunteers after the standard meal. The integrated postprandial CCK level in patients investigated was significantly lower (35 +/- 4.8 pmol/L after 60 min) without any substitution therapy, compared to the integrated peptide amount in healthy volunteers (145 +/- 13.5 pmol/L after 60 min). Enzyme therapy in patients suffering from chronic pancreatitis led to an increased postprandial CCK-level (80 +/- 9.6 pmol/L after 60 min). Elevated CCK-plasma concentrations have not been demonstrated in these patients with pancreatic insufficiency. We therefore suggest that CCK might not play a major role in feedback regulation in patients with chronic pancreatitis. However, in light of elevated NT plasma concentrations in patients with chronic pancreatitis, NT-mediated influence on the pancreas deserves further study.

Topics: Amylases; Cholecystokinin; Chronic Disease; Endopeptidases; Humans; Kinetics; Lipase; Male; Middle Aged; Neurotensin; Pancreatitis; Prospective Studies

Pancreatic secretion of zinc and copper in duodenal juice were measured in 7 healthy persons and in 9 patients with chronic pancreatitis. Stimulation with cholecystokinin and secretin increased secretion of zinc in healthy persons but not in patients. Copper secretion was not influenced. In patients with chronic pancreatitis, the correlations between zinc secretion, and amylase and trypsin secretion were significant while in healthy subjects they were not. Possibly pancreatic zinc secretion in the duodenal juice might be used as a measure of exogenic pancreatic function, and determination of zinc in duodenal juice may replace enzyme determinations in the diagnosis of chronic pancreatitis.

Topics: Adult; Amylases; Cholecystokinin; Chronic Disease; Copper; Female; Humans; Intestinal Secretions; Male; Middle Aged; Pancreas; Pancreatitis; Secretin; Secretory Rate; Trypsin; Zinc

In patients suffering from chronic pancreatitis with concomitant atrophic antral gastritis, gastrinemia is less whereas the response of pancreatic enzymic secretion to pentagastrin is more potent than in patients suffering from chronic pancreatitis without atrophic alterations in the gastroduodenal mucosa. The pancreas-stimulating effect of pentagastrin administered in a dose of 6 micrograms/kg is approximately equal to the action of 0.5 U/kg pancreozymine and noticeably yields to the effect of 1.5 U/kg pancreozymine (according to the criteria for output of intraduodenally secreted lipase and trypsin). The same diagnostic dose of pentagastrin used commonly for gastric secretion studies not only stimulates pancreatic enzyme secretion but also enhances the activity of beta-cells of Langerhans' islets of the pancreas in accordance with insulinemia and blood C-peptide determined by RIA.

Topics: C-Peptide; Cholecystokinin; Chronic Disease; Dose-Response Relationship, Drug; Gastrins; Gastritis, Atrophic; Humans; Insulin; Islets of Langerhans; Pancreas; Pancreatitis; Pentagastrin; Recurrence

CCK cholescintigrams were performed in 374 patients with recurrent postprandial right upper quadrant pain, biliary colic, and a normal gallbladder sonogram and/or cholecystogram. The results of these examinations were correlated with the patients' final medical/surgical diagnoses. Twenty-seven patients recruited as control volunteers without objective clinical evidence of biliary disease also underwent CCK cholescintigraphy to determine if the degree of gallbladder contraction post-CCK differs in symptomatic versus asymptomatic subjects. Decreased gallbladder motor function was identified (maximal gallbladder ejection fraction response to CCK less than 35%) in 94% of patients with histopathologically confirmed chronic acalculous cholecystitis or the cystic duct syndrome and in 88% of patients clinically believed to have chronic acalculous biliary disease. Decreased gallbladder motor function does not distinguish symptomatic from asymptomatic gallbladder disease.

Topics: Cholecystokinin; Chronic Disease; Female; Gallbladder; Gallbladder Diseases; Humans; Imino Acids; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

We have investigated the relationship between cholecystokinin levels and abdominal pain in patients with chronic pancreatitis. The baseline and postprandial cholecystokinin levels were measured in 15 patients with chronic pancreatitis (8 with and 7 without abdominal pain) and in a reference group of 8 healthy subjects. The baseline, 30 and 60 min postprandial plasma cholecystokinin levels were significantly (p less than 0.05) higher in the patients with pain as compared with the other two groups. No correlation was observed between increased cholecystokinin levels and impairment of the exocrine pancreatic function as assessed by the NBT-PABA test. The increased cholecystokinin levels might be an important factor in the genesis of pain in chronic pancreatitis.

Topics: Abdominal Pain; Adult; Cholecystokinin; Chronic Disease; Female; Food; Gastrins; Humans; Male; Pancreatitis; Radioimmunoassay

An investigation of 122 patients with chronic recurrent pancreatitis at different stages of the disease revealed that the most important informative diagnostic value belongs to the level of blood serum trypsin. Transition to the remission stage may be considered only after normalization of the parameters of blood pancreatic enzymes which showed in 1/4 of all cases a 1-2 week delay in normalization of clinical signs of exacerbation. The level of pancreatic amylase, lipase and trypsin in the blood is not able to characterize the external secretory activity of the pancreas but is reflecting the phenomenon of enzyme "deviation" depending on the degree of destructive processes in the pancreas.

Topics: Amylases; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Diagnosis, Differential; Gastrointestinal Contents; Humans; Lipase; Pancreatitis; Recurrence; Trypsin

Insulinemia, concentration of C-peptide and glucagon in the blood was studied in chronic hepatitis patients showing moderate tolerance disorders to glucose and diabetes mellitus developed against the background of chronic pancreatitis. Both groups showed hyperglucagonemia. Basal hypoinsulinemia and reduction of the C-peptide level revealed only in patients suffering of chronic pancreatitis with secondary diabetes mellitus. Reduced reaction of beta-cells of the pancreas to physiologic stimulation by pancreosozymin were observed also in less significant disorders of tolerance to glucose. The authors discuss the significance of changes in the sequential development of different degrees of disorders of the carbohydrate metabolism in patients with chronic recurrent pancreatitis.

Topics: C-Peptide; Carbohydrate Metabolism; Cholecystokinin; Chronic Disease; Diabetes Mellitus; Glucagon; Humans; Insulin; Islets of Langerhans; Pancreatitis; Recurrence

The plasma concentrations of pancreastatin and cholescystokinin (CCK), exocrine pancreatic responses, and gallbladder contraction following intrajejunal ingestion of 100 kcal/hr semidigested liquid meal (Clinimeal) were simultaneously studied in six controls and six patients with chronic pancreatitis. An intrajejunal infusion of Clinimeal resulted in significant rises of pancreastatin and CCK, which paralleled the pancreatic secretion and gallbladder contraction. On the other hand, an intrajejunal infusion of Clinimeal resulted in a delayed rise of pancreastatin and no rise of CCK in chronic pancreatitis. Pancreatic secretion did not increase, and gallbladder contraction was not induced in these patients. It is suggested that pancreastatin may play an important role in the regulation of intestinal phase of exocrine pancreas. The impaired pancreastatin and CCK release in chronic pancreatitis may be due to the inappropriate stimuli in the lumen, which is attributed to pancreatic exocrine dysfunction, or to disturbed physiological regulation between the pancreas and gastrointestinal tract.

Topics: Adult; Bilirubin; Blood Glucose; Cholecystokinin; Chromogranin A; Chronic Disease; Food, Formulated; Humans; Injections; Insulin; Jejunum; Male; Middle Aged; Pancreas; Pancreatic Hormones; Pancreatitis; Radioimmunoassay

The fasting carcinoembryonal antigen (CEA) concentrations in the serum and duodenal juice and after venous stimulation of the exocrine pancreas with the hormones CCK and secretin (Boots) were studied. Radioimmunologic test with a kit of the firm "Labimex"--PPR was used. 28 patients with clinically proved chronic pancreatitis and a control group of 27 healthy persons were examined. The fasting CEA serum concentrations in the patients with chronic pancreatitis were statistically significantly higher than those of the healthy persons--mean--16.5 ng/ml vs mean--8.2 ng/ml (p less than 0.001). In 14% of the healthy persons and 57% of of the patients with chronic pancreatitis the basic CEA concentrations were significantly increased. After stimulation with CCK and secretin the serum CEA concentration did not change substantially. The duodenal juice CEA concentrations after CCK and secretin stimulation were about 11 times higher than those in the serum--mean--113 ng/ml and mean--104 ng/ml for the control group vs mean--118 ng/ml and mean--110 ng/ml for the patients with chronic pancreatitis. No statistically significant difference between the patients with chronic pancreatitis and the control group of healthy persons was established. The results reveal the low specificity of the CEA as a "tumor marker".

Topics: Adult; Carcinoembryonic Antigen; Cholecystokinin; Chronic Disease; Diagnosis, Differential; Duodenum; Evaluation Studies as Topic; Female; Humans; Intestinal Secretions; Male; Middle Aged; Pancreatic Neoplasms; Pancreatitis; Secretin

Investigations of pancreatic juice revealed new insights into the pathogenesis of chronic pancreatitis (cP). But many results are contradictory. In this paper pure human pancreatic juice from patients with cP (n = 14) was compared with results obtained from normal subjects (n = 22). The pancreatic juice was obtained endoscopically recording the absorption (280 nm) simultaneously. By means of this special technique 4 fractions could be exactly distinguished: 1. wash-out-period, 2. phase of secretin action, 3. phase of pancreozymin (CCK) action, and 4. post-CCK-phase. Total protein, trypsinogen, zinc sodium, and potassium were determined. In fraction 1 (wash-out-period) mean values of protein, trypsinogen and zinc are lower in patients with cP compared with control subjects. In case of zinc the difference is statistically significant. In fraction 2 (secretin-phase) no differences could be detected between cP and control subjects. In contrast in fraction 3 (CCK-phase) mean values of protein and trypsinogen are lower in control subjects than in patients with cP. But the standard deviations are so high that all differences are not statistically significant. The results indicate that under fasting conditions the pancreatic juice content of protein, trypsinogen and zinc is lower in patients with cP. But patients with cP can be stimulated much better with CCK than control subjects. Till now such a different behaviour during wash-out-period and CCK-stimulation is not reported in the literature.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Humans; Pancreatic Function Tests; Pancreatic Juice; Pancreatitis; Potassium; Proteins; Secretin; Sodium; Trypsinogen; Zinc

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatic Pseudocyst; Pancreatitis; Paris

Topics: Biological Assay; Brain; Cholecystokinin; Cholestasis; Chronic Disease; Diabetes Mellitus; Humans; Intestinal Mucosa; Pancreatitis; Radioimmunoassay; Specimen Handling; Tissue Distribution

Topics: Amylases; Animals; Cells, Cultured; Cholecystokinin; Chronic Disease; Glucocorticoids; Insulin; Lipase; Pancreas; Pancreatic Extracts; Pancreatitis; Rats; Rats, Inbred Strains

We developed a specific and sensitive bioassay for measuring plasma cholecystokinin (CCK) in human and investigated CCK response after a test meal in patients with chronic pancreatitis. Treatment with cycloheximide increased the sensitivity and responsiveness of isolated rat pancreatic acini to CCK-octapeptide (CCK-8) and thus plasma levels of CCK-8 as low was 0.17 pM were detectable. Fasting plasma CCK levels in normal subjects as CCK-8 equivalents were 0.75 +/- 0.25 pM and rose to a peak of 6.2 +/- 0.68 pM at 45 min after a test meal consisting of 400 ml milk and 2 boiled eggs. Basal and stimulated plasma levels of CCK-8 in patients with non-calcified chronic pancreatitis were significantly higher than those in normal subjects. In contrast, postprandial responses of plasma CCK-8 in patients with calcified chronic pancreatitis was significantly low compared to those in control subjects, although basal plasma levels were not significantly different from those in controls.

Topics: Amylases; Animals; Biological Assay; Cholecystokinin; Chronic Disease; Humans; In Vitro Techniques; Pancreas; Pancreatitis; Rats

We studied the responses of pancreatic polypeptide (PP) and cholecystokinin (CCK) using specific RIAs, and simultaneously exocrine pancreatic secretion and gall bladder contraction were checked by using triple lumen tube to intraduodenal ingestion of 100 Kcal/hr semi-digested liquid meal: Clinimeal (Eisai, Tokyo) or Elemental Diet: ED (Morishita, Osaka) in 10 patients with chronic pancreatitis (CP). Intraduodenal infusion of Clinimeal did not result in a significant physiological rise of CCK and PP from the basal values. Pancreatic secretions (volume and bicarbonate output) were slightly increased paralleled to the gall bladder contraction in chronic pancreatitis. On the other hand, intraduodenal ED can significantly stimulate the release of CCK from the small intestine and PP from the pancreas with the near range of physiological concentration. This level of CCK can evoke a significant increase in pancreatic secretion and gall bladder contraction. These results suggest that in CP the physiological regulation was disturbed and pancreatic secretion was not observed after ordinary meal ingestion. Infusion of ED which contained similar components of digestive product partially improved the responses of gut hormones and pancreatic secretion. Therefore, impaired gut hormone release in CP primarily is due to the inappropriate stimuli because of pancreatic exocrine dysfunction, and not other factors(s).

Topics: Cholecystokinin; Chronic Disease; Duodenum; Food, Formulated; Gastrointestinal Hormones; Humans; Infusions, Parenteral; Pancreas; Pancreatic Polypeptide; Pancreatitis

Secretion of pancreatic enzymes is inhibited in rats by the presence of intraduodenal proteases via inhibition of CCK release. The existence of a similar feedback mechanism in man is discussed controversially. Thus, in chronic pancreatitis (cP), which leads to a decrease of digestive enzyme secretion, increases in plasma CCK may be postulated. However, food induced CCK release may be impaired in cP due to maldigestion. We studied, therefore, the influence of food with or without addition of pancreatic extracts on plasma CCK in 16 male patients with longstanding cP. Plasma CCK was measured by bioassay using pancreatic rat acini prepared by collagenase digestion. Plasma samples were processed through SEP-PAK cartridges and assayed for CCK-like activity by comparing the bioactivity of samples with those of standard curves of CCK8. Plasma CCK was measured in 20 healthy controls and in cP prior and 7.5, 15, 30, 45, 60, and 90 min after the application of a test meal made out of milk, cream, eggs, and cacao. In addition CCK was measured in 10 of the same patients with cP on a separate day but with the addition of pancreatic extracts to the test meal. Basal plasma CCK levels were similar in both groups (control: 1.3 +/- 0.2 vs. cP: 1.5 +/- 0.3 pMol/l). Both groups showed a similar steep increase of postprandial CCK with maximal values seen between 7.5 and 30 min (control: 4.6 +/- 0.6 vs cP: 4.8 +/- 1.3 pMol/l). The addition of pancreatic extracts to the liquid meal in cP caused a statistically significant slight increase in plasma CCK.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Cholecystokinin; Chronic Disease; Humans; Male; Middle Aged; Pancreatic Extracts; Pancreatitis

Plasma cholecystokinin (CCK) and human pancreatic polypeptide (hPP) responses after ingestion of a liquid test meal rich in medium-chain fatty acids (MCFA) were studied in patients with chronic pancreatitis with or without diabetes mellitus (DM). Integrated response of plasma CCK was significantly lower in patients with chronic pancreatitis and DM than in the two other groups. There was no statistically significant difference between the healthy control subjects and the patients with chronic pancreatitis without DM in the integrated responses of hPP and plasma CCK. These results indicate that diabetic patients with a greatly destroyed pancreas do not release as much CCK as do nondiabetic patients with a mildly impaired pancreas. An MCFA meal is therefore considered safe in patients with a mildly impaired pancreas. For diabetic patients, however, care should be taken not to exacerbate the DM.

Topics: Adult; Cholecystokinin; Chronic Disease; Diabetes Complications; Dietary Fats; Fatty Acids; Female; Food, Formulated; Humans; Male; Middle Aged; Pancreatic Polypeptide; Pancreatitis

Exocrine pancreatic insufficiency has been observed in some diabetics with peripheral neuropathy and diarrhea. Several mechanisms may be responsible for this insufficiency: (1) pancreatic atrophy, (2) disruption of the cholinergic enteropancreatic reflexes, or (3) elevated serum levels of peptides such as glucagon and pancreatic polypeptide which are known to inhibit pancreatic exocrine secretion. To clarify the mechanism(s) involved in this exocrine pancreatic impairment, we studied 10 diabetics with diarrhea and peripheral neuropathy. Their results were compared to those of eight normal volunteers. Each subject underwent a standardized pancreatic function study which assessed nonstimulated secretion, the response to intrajejunal infusion of a mixture of amino acids, and the output following intravenous administration of secretin and cholecystokinin (CCK). In separate studies, the effect of a background infusion of bethanechol and secretin on the pancreatic response to CCK was assessed in six patients and six normal controls. Compared to normals, all diabetics exhibited a significant reduction in both enzyme and bicarbonate secretion to all stimuli. This reduction was not corrected by administering bethanechol. Plasma glucagon and pancreatic polypeptide levels in diabetics were not significantly higher than those in controls. We conclude that diabetics with diarrhea and peripheral neuropathy exhibit impairment of their exocrine pancreatic secretion and possible mechanisms for this are discussed.

Topics: Adult; Amino Acids; Bethanechol; Bethanechol Compounds; Cholecystokinin; Chronic Disease; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Diarrhea; Dose-Response Relationship, Drug; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Pancreas; Secretin

Topics: Acute Disease; Animals; Cholecystokinin; Chronic Disease; France; Humans; Mice; Pancreas; Pancreatic Hormones; Pancreatic Pseudocyst; Pancreatitis; Rats

The cholecystographic pattern and the contractile response of the gallbladder (GB) to cholecystokinin (CCK) were studied in 101 consecutive patients with uncomplicated chronic cholecystitis confirmed by pathology. Sequential GB images were obtained after administration of 5 mCi 99mTc-Disofenin and the ejection fraction was determined following a 15 min infusion of CCK. Sixteen of 101 (16%) GB failed to visualize up to 4 h; of the remaining patients, 3/85 (4%) showed delayed visualization beyond 1 h, and 82/85 visualized within 1 h. The mean ejection fraction (EF) in 67 patients was 56.9% +/- 27.5% compared to 74.8% +/- 19.8% in a normal control group of 27 subjects (P less than 0.005). However, there was a large overlap as 76% of chronic cholecystitis patients had EF values falling within the full normal range. GB disease could be identified with confidence when the EF was less than 35%, i.e. below the 2 standard deviation range of normal. On the basis of radionuclide kinetic studies alone, the majority of patients with chronic cholecystitis cannot be distinguished from normal.

Topics: Adult; Aged; Cholecystitis; Cholecystokinin; Chronic Disease; Female; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Technetium Tc 99m Disofenin

The biliary secretion of bile acids was measured with the modified secretin-pancreozymin test in 50 patients with various gastroenterological diseases and in a control group. In the control group the highest bile acid output and the lowest G/T quotient was estimated. In comparison to the control group, the bile acid output in the patients with gastroenterological disorders was reduced significantly to a varying degree. Except in postcholecystectomy patients, it was proved that the G/T quotient was significantly increased compared to that in the control group. The estimation of bile acid output and the G/T quotient presented here shows an easier extension of the validity of the secretin-pancreozymin test which does not indice any additional burden to the patients.

Topics: Adult; Aged; Bile Acids and Salts; Cholecystectomy; Cholecystokinin; Chronic Disease; Crohn Disease; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Pancreatitis; Postoperative Complications

Topics: Cholecystokinin; Chronic Disease; Diabetes Mellitus; Hepatitis, Viral, Human; Humans; Liver Circulation; Pancreatitis; Pentagastrin; Plethysmography, Impedance

Human pure pancreatic juice (PPJ) and serum were analyzed for free fatty acids (FFAs) to study whether the damage to pancreatic cell membranes in pancreatitis is reflected as abnormal FFAs concentration and composition. Patients consisted of 13 normal controls, 7 patients with acute pancreatitis (AP) in remission, and 27 with chronic pancreatitis (CP). PPJ was collected at 2-min intervals after secretin and then cholecystokininpancreozymin stimulation by endoscopic cannulation of the pancreas. The following results were obtained: (a) serum FFAs concentration and composition showed no significant difference between the three groups. (b) FFAs concentration in PPJ was significantly raised in CP through all secretory phases. The rise was significant only in "secretin phase" in AP. In many of the cases with raised FFAs concentration in PPJ, the FFAs composition was similar to that in serum. (c) Arachidonic acid, undetected in normal PPJ, was disproportionately high in concentration and composition in PPJ of eight patients with CP. Two mechanisms were proposed to explain these abnormalities: transudation of serum FFAs into the pancreatic duct and local production of arachidonic acid as a result of the damage to pancreatic cell membranes.

Topics: Acute Disease; Adult; Cholecystokinin; Chromatography, Gas; Chronic Disease; Fatty Acids, Nonesterified; Female; Humans; Male; Middle Aged; Pancreatic Juice; Pancreatitis; Secretin; Trypsin

Topics: Adult; Animals; Aprotinin; Bicarbonates; Cholecystokinin; Chronic Disease; Dogs; Female; Gabexate; Guanidines; Humans; Injections, Subcutaneous; Lipase; Male; Octreotide; Pancreas; Pancreatitis; Receptors, Cholecystokinin; Secretin; Somatostatin; Trypsin

We determined by the ninhydrin method the plasma amino acid (AA) levels prior to, during and following, a 1-hour i.v. infusion of 1 U/kg body weight each of secretin and pancreozymin in patients with normal (n = 74) or reduced (n = 39) exocrine pancreatic function, as assessed by the duodenal aspiration test. The results of the two tests correlated significantly with each other (p less than 0.001). A maximum AA decrease of greater than or equal to 12% was observed in all patients with a normally functioning pancreas (specificity 100%), and of less than 12% in all patients with medium to high-grade impairment of pancreatic function (sensitivity 100%). Since, however, low-grade pancreas insufficiency (20-40% of the mean normal enzyme output) is recognized in fewer than one-half of the cases, the overall sensitivity of the AA-consumption test decreases to 69%. The results can, however, be improved by: 1) Calculating the mean percentage AA decrease with a limit value of 5% (sensitivity 90%); 2) determining individual AA with pancreas-specific absorption, such as serine (sensitivity 92%); 3) dropping the lower normal value of exocrine pancreatic function to 25% of the normal mean enzyme output (sensitivity 96%). Diseases that may be associated with the most common condition that causes pancreatic insufficiency--chronic pancreatitis--and which have an influence on AA metabolism, such as cirrhosis of the liver and diabetes mellitus, have no influence on the accuracy of the AA consumption test, which, considered overall, represents a competitive alternative to other tubeless tests of pancreatic function.

Topics: Adult; Aged; Amino Acids; Ceruletide; Cholecystokinin; Chronic Disease; Exocrine Pancreatic Insufficiency; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Nitrogen; Pancreatic Function Tests; Pancreatitis; Secretin

A sufficient number of good retrieval rates (median value 88.9%) could be achieved by means of radiovitamin B12 in 20 patients who underwent a secretin-pancreozymin test. Losses of this amount can be tolerated for practical purposes. As a rule, marker losses are caused by a flow-off into deeper intestinal sections. The marker technique raises a great number of unexplained issues.

Topics: Cholecystokinin; Chronic Disease; Exocrine Pancreatic Insufficiency; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Secretin; Secretory Rate

A modified secretin-pancreozymin test was performed for the quantitative determination of both the pancreatic exocrine function and the biliary secretion of total bile acids followed by exogenous (secretin and pancreozymin) and endogenous (L-phenylalanine) stimulation of the pancreatic and biliary secretion. The outputs of lipase, alpha-amylase, trypsin, bicarbonate and total bile acids were estimated and the ratio of glycine to taurine conjugated bile acids was measured by thin layer chromatography. Polyethylene glycol 4,000 was used as a nonabsorbable marker for the correction of aspirated volumes. 40 patients were studied: 10 control subjects; 10 control subjects with previous cholecystectomy; 10 patients with chronic pancreatitis and 10 cholecystectomized patients with chronic pancreatitis. In cholecystectomized probands, not only the total bile acid output but also the output of bicarbonate, trypsin and lipase were diminished compared to the control subjects with a intact gallbladder. In noncholecystectomized and cholecystectomized patients with chronic pancreatitis both, the pancreatic secretion and the biliary bile acid secretion were significantly decreased. The ratio of glycine/taurine conjugated bile acids was found to be significantly higher in these patients compared to the controls.

Topics: Adult; Aged; Bile Acids and Salts; Cholecystectomy; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Postoperative Complications; Secretin; Secretory Rate

The test-combination from Fa. Boehringer Mannheim GmbH for measuring citric acid present in foodstuffs is also suitable for use in human pancreatic juice. Accuracy, within-run and between-day imprecision are satisfactory. The detection limit of the method is at least 10 mumol citrate/l pancreatic juice. The limit can be reduced when exact additions of citrate are given to the pancreatic juice and then evaluated using regression analysis. The presence of Ca-ions and possibly also trypsin in the material to be tested does not interfere with the reaction. It is, however, necessary to remove proteins from the sample. Deproteinization can be performed either by ultrafiltration or with perchloric acid.

Topics: Cholecystokinin; Chronic Disease; Citrates; Citric Acid; Humans; Pancreatic Juice; Pancreatitis; Secretin

We examined diurnal changes of pancreatic exocrine secretion and plasma levels of cholecystokinin (CCK) and human pancreatic polypeptide (hPP) in men with postoperative transient external pancreatic drainage (3 with pancreatico-jejunostomy: PJ, and 5 with pancreato-duodenectomy:PD). Plasma CCK levels increased and the pancreatic exocrine secretion showed a corresponding increase after meals in both groups. In the PJ group hPP levels increased after meals and there was a significant correlation between the plasma levels of CCK and hPP. In the PD group the plasma hPP levels were not detectable throughout the study and there was a better correlation between the exocrine secretion and the plasma CCK levels than in the PJ group. Plasma CCK levels showed rhythmic changes associated with pancreatic exocrine secretion, with no significant changes in plasma glucose and insulin in the night (24:00-07:00). These results suggested that (1) the resection of the pancreatic head which is rich in hPP contents led to a complete loss of anti-CCK effects on CCK, and that (2) fluctuation in plasma CCK levels, in the fasting state, might initiate pancreatic exocrine secretion.

Topics: Aged; Cholecystokinin; Chronic Disease; Circadian Rhythm; Humans; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Pancreatic Polypeptide; Pancreatitis; Postoperative Care

A method for the continuous detection of secretory profiles of human pure pancreatic juice is described. After retrograde cannulation of the D. pancreaticus the exocrine pancreas was stimulated by an intravenous infusion of secretin and a bolus injection of pancreozymin additionally. The absorbance of pancreatic juice at 280 nm was measured continuously using an Uvicord-UV-Photometer which was connected directly with a Teflon catheter localised in the main pancreatic duct. The secretory profiles obtained from patients without pancreatic diseases (n = 12) indicated a first maximum of absorbance after secretin infusion and a second one in response to pancreozymin bolus injection. Alterations of secretory profiles in patients with chronic pancreatitis (n = 10) were evident after pancreozymin administration principally.

Topics: Adult; Aged; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Function Tests; Pancreatic Juice; Pancreatitis; Secretin; Secretory Rate

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

Topics: Cholecystokinin; Chronic Disease; Humans; Intestinal Pseudo-Obstruction; Male; Neostigmine; Parasympathomimetics

Fourteen patients with suspected chronic alcoholic pancreatitis (CAP) and 21 patients who had been shown to have the disease were followed up by the pancreozymin-secretin test in order to clarify the serial changes in exocrine pancreatic function in alcoholic pancreatitis. The initial and final test data for secretory volume, maximal bicarbonate concentration, bicarbonate output (BO), and amylase output (AmO) of exocrine secretion were compared in these two groups. Patients with suspected CAP showed a significant serial decrease only in AmO; definite CAP developed in 3 of them during the follow-up period. In definite CAP, a significantly progressive decrease in BO as well as AMO was observed. It is suggested that in the earlier stage of CAP, AMO is initially affected, whereas decreased secretion of both bicarbonate and enzyme becomes apparent in the later stage.

Topics: Adult; Aged; Alcoholism; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Function Tests; Pancreatitis; Secretin

Topics: alpha-Amylases; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Duodenum; Gastrointestinal Contents; Humans; Hydrochloric Acid; Pancreatitis; Secretin

The influence of the pancreatic secretion on the absorption of iron supposed by several authors could be ascertained by the investigation of pancreatic juice which was obtained by means of cannulation of the pancreatic duct and subsequent stimulation of the organ with secretin pancreozymin in patients with haemochromatosis. The absorption of iron increased in this disease can on the one hand be caused by a protracted secretion of hydrogen carbonate and the slower decrease of the pH-value in the upper duodenum, on the other hand by an increased secretion of pancreatic protein. The quantity of hydrogen carbonate decides on the speed of neutralisation of the formerly acid chyme, however, together with the proteins being at the disposal on the formation of absorption-promoting iron-chelates or of not bioavailable, partly polymeric iron hydroxides.

Topics: Bicarbonates; Carrier Proteins; Cholecystokinin; Chronic Disease; Hemochromatosis; Hemosiderosis; Humans; Hydrogen-Ion Concentration; Intestinal Absorption; Iron; Iron-Binding Proteins; Pancreatic Juice; Pancreatitis; Secretin; Transferrin; Transferrin-Binding Proteins

Plasma cholecystokinin (CCK) responses after ingestion of a test meal in patients with mild chronic pancreatitis having abdominal pain were studied with a radioimmunoassay using the CCK specific antiserum (OAL-656) produced by a novel immunization procedure. Mean concentration of the fasting plasma CCK determined using CCK-8 as a standard was 31.5 +/- 5.8 pg/ml in six patients who had mild impaired exocrine function with pain, and was significantly higher than 10 healthy subjects (9.8 +/- 1.8 pg/ml). In those patients, the ingestion of a liquid test meal led to a peak of 75.1 +/- 25.4 pg/ml at 30 min, and the 120-min integrated CCK response (5427 +/- 1217.3 pg X min/ml) was significantly higher than in healthy subjects (1538 +/- 110.1 pg X min/ml).

Topics: Abdomen; Adult; Blood Glucose; Cholecystokinin; Chronic Disease; Fasting; Feedback; Female; Food; Humans; Insulin; Male; Middle Aged; Pain; Pancreas; Pancreatic Diseases; Pancreatic Polypeptide; Radioimmunoassay

Plasma concentrations of cholecystokinin (CCK) have been reported to be elevated in patients with chronic pancreatitis. The elevations are suggested to be due to increased release of CCK from the upper small intestine secondary to the absence of protease activity (trypsin and chymotrypsin) in the intestinal lumen. We have studied plasma CCK levels before and after liquid as well as solid meals in eight patients with pancreatic insufficiency due to advanced chronic pancreatitis and in eight healthy controls. CCK concentrations were measured with a sensitive and specific radioimmunoassay using an antibody directed against the sulfated tyrosyl region of CCK. No differences in basal or maximal postprandial plasma CCK levels between patients and controls were observed. In the liquid meal study, basal CCK concentrations in patients and controls were 2.2 +/- 0.7 and 2.5 +/- 0.4 pM, respectively, with maximal postprandial concentrations of 9.6 +/- 2.2 and 11.2 +/- 1.4 pM. In the solid meal study, basal CCK concentrations in patients and controls were 2.5 +/- 0.6 and 2.6 +/- 0.4 pM, respectively, with maximal postprandial concentrations of 9.4 +/- 1.6 and 8.6 +/- 1.4 pM. The only difference observed was a significantly longer time interval to maximal plasma CCK levels in patients as compared with controls after the liquid meal. Two patients with no detectable trypsin activity in the small intestinal lumen during a Lundh test meal had basal CCK levels of 1.3 and 1.8 pM. Thus, the present study does not support the hypothesis that trypsin is involved in the regulation of CCK release.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cholecystokinin; Chronic Disease; Food; Humans; Pancreatitis; Radioimmunoassay; Time Factors

Complex evaluation of secretin-pancreozymin test data with multivariate statistical methods was performed in patients with pancreatic insufficiency and in controls. The centroid, the nearest neighbour methods and the linear discriminant analysis led to the correct diagnosis in 84, 77 and 92%, respectively, when the overall responses to synthetic secretin plus cholecystokinin-octapeptide were evaluated. Results of individual stimulations were less precise. The linear discriminant analysis also successfully separated the patients with mild chronic pancreatitis from the healthy subjects, and seems to provide a useful support in medical diagnosis, particularly in controversial cases.

Topics: Cholecystokinin; Chronic Disease; Data Interpretation, Statistical; Humans; Pancreatitis; Pattern Recognition, Automated; Secretin

Using an inhibitor method, fasting levels of pancreatic isoamylase were measured in 46 healthy controls and in 218 patients undergoing a secretin-pancreozymin test for diagnostic purposes, and compared with immunoreactive trypsin (IRT). Exocrine pancreatic insufficiency was found in 82 of the patients. The specificity of both enzymes was high in patients with nonpancreatic diseases (pancreatic isoamylase: 98.5%, IRT: 96.3%). No patient with nonpancreatogenic steatorrhea had a low serum enzyme value. Sensitivity was, unfortunately, low in patients with exocrine pancreatic insufficiency (pancreatic isoamylase: 45.1%, IRT: 41.5%) and increased only slightly when patients after an acute attack of the disease, or patients with pseudocysts or older than 60 were excluded (pancreatic isoamylase: 67.9%, IRT: 58.5%). Although highly specific, pancreatic isoamylase measurement is not sensitive enough to be used as a screening test for exocrine pancreatic insufficiency but may be used to determine the etiology of steatorrhea.

Topics: Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Glycoside Hydrolases; Humans; Isoamylase; Pancreas; Pancreatic Function Tests; Pancreatitis; Prospective Studies; Trypsin

Chronic pancreatitis has been reported to be associated with an increased secretion of calcium in pancreatic juice. To determine whether estimation of duodenal calcium may be useful for diagnosing chronic pancreatitis, we compared duodenal calcium output in patients with chronic pancreatitis and in subjects without pancreatic disease, during intravenous infusion of secretion alone, with calcium, or with cholecystokinin-pancreozymin (CCK-PZ). Duodenal calcium output increased during infusion of both calcium and CCK-PZ to a similar extent in chronic pancreatitis and controls. Overall, duodenal output of chymotrypsin was markedly lower in chronic pancreatitis; however, chymotrypsin output increased in response to both intravenous calcium and CCK-PZ in both groups. Bilirubin output increased in both groups during calcium infusion, but this increase was significantly reduced in chronic pancreatitis; in contrast, CCK-PZ caused a similar increase in both groups. The high calcium output observed in hypercalcemia in the presence of low enzyme output suggests increased pancreatic secretion of enzyme-independent calcium in chronic pancreatitis. However, the difference is obscured by biliary calcium, which is secreted in much higher concentrations. Thus, duodenal calcium determination does not appear to be a useful diagnostic test in chronic pancreatitis.

Topics: Bilirubin; Calcium; Cholecystokinin; Chronic Disease; Chymotrypsin; Clinical Laboratory Techniques; Duodenum; Humans; Pancreatitis; Secretin; Spectrophotometry, Atomic

The results of the secretin-CCK test were compared with the histological findings of pancreatic tissue resected in 25 patients with chronic pancreatitis. Secretin-CCK test results were interpreted with the use of discriminant analysis, yielding a quantitative score for each patient. Histological findings were recorded according to a semiquantitative scale. Fairly high correlation coefficients were found between secretin-CCK test results and severity of acinar atrophy and small dilatation. These findings emphasize the importance of the secretin-CCK test for diagnostic and follow-up purposes in chronic pancreatitis.

Topics: Adult; Cholecystokinin; Chronic Disease; Female; Humans; Male; Pancreas; Pancreatitis; Secretin

Thirty-three patients with chronic pancreatitis were studied in an effort to correlate release of gastrointestinal hormones (GIH) with the degree of pancreatic insufficiency. A prospective examination was conducted of fat-stimulated release of pancreatic polypeptide (PP), cholecystokinin (CCK), and neurotensin. Seventy-two-hour fecal fat determination, endoscopic retrograde pancreatography (ERP), and the bentiromide-PABA test were used to correlate the clinical stage of disease. The ERP was classified as positive only if the changes were advanced (or "marked") according to the Cambridge Classification. Five patients were defined to have mild disease, 13 moderate, and 15 severe. Any patient with clinical evidence of chronic pancreatitis and ERP changes that were less than advanced and had normal fecal fat and bentiromide tests received a grade of mild. Patients with one abnormal test were graded moderate, and those with two or three abnormal results were graded severe. In the 33 patients, the integrated 60-minute release of pancreatic polypeptide (PP) was 37.4 +/- 6.1 ng-60 min/ml in those five patients with mild disease, 102.3 +/- 10.3 ng-60 min/ml in the 13 patients with moderate disease, and 7.6 +/- 2.2 ng-60 min/ml in the 15 patients with severe disease. The integrated 60-minute release of neurotensin was 3.8 +/- 0.4 ng-60 min/ml in mild disease, 2.0 +/- 0.3 ng-60 min/ml in moderate disease, and 0.2 +/- 0.1 ng-60 min/ml in severe disease. CCK release did not correlate with the severity of disease. Enhanced release of PP appeared to correlate well with moderate stage of chronic pancreatitis, and depressed PP release with severe disease. Stimulated levels of PP and neurotensin appear to be useful in the diagnosis and staging of chronic pancreatitis. It is concluded that measurement of fat-stimulated release of PP and neurotensin may be useful to assess severity of disease in patients with chronic pancreatitis.

Topics: Adult; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Neurotensin; Pancreatic Function Tests; Pancreatic Polypeptide; Pancreatitis; Prospective Studies

Using validated double-marker techniques to quantitate tryptic secretion we found that the mean 10-min output of trypsin in duodenal juice after a test meal was very similar to the peak 10-min output of trypsin after pancreozymin (2 Crick-Harper-Raper units/kg, Boots) both in controls as well as in non-diabetic patients with idiopathic chronic pancreatitis. These results show that the disproportionate reduction in mean tryptic activity after endogenous compared with exogenous stimulation in chronic pancreatitis is not due to impaired release of cholecystokinin-pancreozymin from the small intestine, nor to refractoriness of the pancreas to endogenously released hormone: instead, it is due to overdilution of secreted pancreatic enzymes because of accelerated gastric emptying, with or without gastric acid hypersecretion.

Topics: Cholecystokinin; Chronic Disease; Duodenum; Food; Gastric Acid; Gastric Emptying; Gastric Juice; Humans; Hydrogen-Ion Concentration; Pancreatitis; Trypsin

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatitis; Secretin

Total plasma amino acids were determined by the ninhydrin method in 37 controls and 30 patients with chronic pancreatitis and normal (n = 7) pancreatic enzyme output or mildly (n = 6), moderately (n = 8), and severely (n = 9) reduced pancreatic enzyme output. Intravenous injection of synthetic secretin did not change plasma amino acid levels. During a combined intravenous infusion of secretin (1 CU/kg X h) and pancreozymin (1 Ivy dog unit/kg X h), amino acid concentrations decreased maximally by 31% +/- 19% (mean +/- SD) in controls, but only by 6.3% +/- 4.7% in patients with exocrine pancreatic insufficiency (p less than 0.001 vs. controls). At a cutoff limit of less than or equal to 12% for the decrease in total amino acids, mild exocrine insufficiency (20%-40% of mean normal chymotrypsin output) was identified with a sensitivity of 67%, whereas moderately to severely impaired function was detected in every case (overall sensitivity 91%). Pancreatic function, as assessed by duodenal intubation and the tubeless amino acid test, was significantly correlated (e.g., rs = 0.73 for chymotrypsin output, p much less than 0.001). In 15 controls and 13 patients with mildly (n = 5) to severely impaired pancreatic function, individual amino acids were estimated. Plasma serine kinetics completely distinguished both groups. Kinetics of serine, valine, isoleucine, and histidine correlated even better with pancreatic function than those of total amino acids.

Topics: Adult; Aged; Amino Acids; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Secretin

Discriminant analysis was used to interpret the results of the secretin-cholecystokinin (CCK) test in the diagnosis of chronic pancreatitis. An allocation rule based on the use of two test variables--mean chymotrypsin concentration and peak bicarbonate output--was constructed to distinguish between 63 patients with chronic pancreatitis and 68 patients without organic disease. These latter patients had signs and symptoms similar to those of the patients with chronic pancreatitis and were used as controls. The allocation rule was applied to a larger set of individuals, including 105 patients with various other diseases. The sensitivity of the test was 83%, and the specificity was 89%. With a prevalence of chronic pancreatitis of 27% in this set of individuals, the positive predictive value was 73%, the negative predictive value was 93%, and the accuracy rate 87%. This diagnostic performance of the secretin-CCK test gives the test a meaningful place in the examination of patients suspected of having chronic pancreatitis.

Topics: Adult; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Pancreatitis; Secretin; Statistics as Topic

Plasma concentrations of human pancreatic polypeptide (HPP) parallel exocrine pancreatic secretion in response to stimulation with cholecystokinin. We determined prospectively the relationships among fasting HPP level, integrated HPP response to infusion of cholecystokinin, and output of trypsin and also the sensitivity, specificity, and predictive values of the fasting HPP level in the diagnosis of exocrine pancreatic disease. Our study group consisted of 19 patients with acute pancreatitis, 17 with chronic pancreatitis, and 25 with ductal adenocarcinoma of the pancreas and 27 control subjects. In the control patients and those with chronic pancreatitis, significant correlations were detected between HPP level and output of trypsin (P less than 0.001) in response to infusion of cholecystokinin and between fasting HPP and integrated HPP levels (P less than 0.004); no correlation was detected between HPP level and steatorrhea. The sensitivity, specificity, and negative and positive predictive values of the fasting HPP level for detection of either chronic pancreatitis or pancreatic cancer were similar and approximated 0.88, 0.67, 0.88, and 0.66, respectively. The HPP concentration had no value in detecting acute pancreatitis. Because the fasting HPP level has a high degree of negative predictability and is simpler to measure than the integrated HPP level or the output of trypsin, it may be a useful test in patients suspected of having either chronic pancreatitis or pancreatic cancer. A fasting HPP level of 125 pg/ml or greater could be used to exclude chronic pancreatitis or pancreatic cancer, but the finding of a value of less than 125 pg/ml necessitates use of other diagnostic tests for reliable determination of the presence of these diseases.

Topics: Acute Disease; Adult; Aged; Carcinoma, Intraductal, Noninfiltrating; Celiac Disease; Cholecystokinin; Chronic Disease; Fasting; Humans; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatic Polypeptide; Pancreatitis; Prospective Studies; Trypsin

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

Topics: Adult; Cholecystokinin; Chronic Disease; Humans; Middle Aged; Narcotics; Nerve Block; Pain; Pain Management; Pancreas; Pancreatic Ducts; Pancreatic Extracts; Pancreatic Pseudocyst; Pancreatitis; Peptic Ulcer; Secretin

Previous studies have suggested that intraduodenal protease suppression of pancreatic exocrine secretion may be mediated through cholecystokinin (CCK) release. Our study compares basal plasma immunoreactive CCK concentrations in normal human subjects with those obtained in patients with chronic pancreatitis. Fasting plasma samples were collected from 18 normal subjects and from 18 patients with chronic pancreatitis. Eight patients had mild to moderate pancreatic exocrine impairment, and 10 had severe exocrine insufficiency. Venous plasma immunoreactive CCK concentrations were measured with two distinct peptide region-specific antibodies. Basal plasma CCK concentration in controls was 14.3 +/- 1.3 fmol/ml (mean +/- SEM), a value significantly less than that obtained in all patients with chronic pancreatitis, 30.1 +/- 4.0 fmol/ml (p less than 0.001). Patients with mild to moderate impairment had a fasting plasma CCK concentration of 32.8 +/- 7.9 fmol/ml (vs. control p less than 0.01), and those with severe disease 27.9 +/- 3.6 fmol/ml (vs. control p less than 0.001). In five patients with mild to moderate impairment of exocrine function and pancreatic extract-responsive abdominal pain, there was a 39 +/- 11% decrease in basal CCK levels during extract therapy (p less than 0.05). Results of this study indicate that pancreatic exocrine impairment is associated with elevated basal CCK levels, which may reflect a failure to provide feedback downmodulation of CCK release.

Topics: Adult; Cholecystokinin; Chronic Disease; Exocrine Pancreatic Insufficiency; Fasting; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Extracts; Pancreatitis; Radioimmunoassay

Topics: Cholecystokinin; Chronic Disease; Diagnosis, Differential; Duodenoscopy; Humans; Male; Middle Aged; Pancreatic Juice; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Gallbladder Diseases; Humans

Hexose and hexosamine contents were measured in 117 samples of either duodenal or pancreatic juice from 49 subjects. The specimens were obtained by three methods: firstly, through a Dreiling's double lumen tube and with a pancreozymin secretin test performed simultaneously; secondly, by fiber duodenoscopy after an intravenous injection of secretin; thirdly, through a postoperative cannula without stimulation. The hexose content measured by phenol-sulfuric acid reaction correlated well with the hexosamine content measured by the Elson-Morgan method (r = 0.63, p less than 0.005). Since determination of hexose is not as complicated as that of hexosamine, the measurement of hexose content in the pancreatic juice seems to be more useful than measuring hexosamine for obtaining valuable information on pancreatic abnormalities.

Topics: Cholecystokinin; Chronic Disease; Duodenum; Hexosamines; Hexoses; Humans; Intestinal Secretions; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin; Stomach Neoplasms

Using a sensitive and specific radioimmunoassay for cholecystokinin (CCK) we have measured plasma CCK levels in patients with and without chronic pancreatitis. All patients suffered from steatorrhea. The basal plasma values in patients with chronic pancreatitis (n = 10) were significantly higher compared with a control group of 40 normal subjects. After ingestion of a test meal peak plasma levels of CCK were significantly higher than in controls, but the integrated CCK release did not differ from the normal subjects. The findings indicate a close relationship between plasma CCK concentration and exocrine pancreatic function.

Topics: Adult; Celiac Disease; Cholecystokinin; Chronic Disease; Female; Food; Humans; Male; Middle Aged; Pancreatitis; Radioimmunoassay; Time Factors

We reviewed 57 patients, who during the last four years had cholecystokinin cholecystography during evaluation of abdominal pain, and found this test to be reliable for diagnosing chronic acalculous cholecystitis. Eighty-eight percent of the patients in whom abdominal pain was reproduced during cholecystokinin cholecystography and who had less than 50% contraction of the gallbladder were cured or improved after cholecystectomy.

Topics: Adult; Aged; Cholecystectomy; Cholecystitis; Cholecystography; Cholecystokinin; Chronic Disease; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Middle Aged

Postprandial responses of plasma cholecystokinin (CCK) in patients with severe chronic pancreatitis (n = 7) were studied. Plasma CCK level rose from 11.2 +/- 1.8 pg/ml at the basal level to a maximum of 23.3 +/- 3.0 pg/ml at 10 min after the ingestion of a liquid meal in healthy subjects (n = 6). However, such significant plasma CCK response to the meal was not observed in patients with chronic pancreatitis in whom CCK levels rose from a basal level of 9.7 +/- 0.91 pg/ml to a peak of 13.8 +/- 1.6 pg/ml at 60 min. It is suggested that the low response of CCK after the meal might reflect impaired function of the enteropancreatic axis to intraluminal stimuli in patients with severe chronic pancreatitis.

Topics: Adult; Cholecystokinin; Chronic Disease; Eating; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis

In 3 healthy men and 4 healthy women, and in 5 men and 2 women with confirmed chronic relapsing pancreatitis (CRP) the inhibitory effect of somatostatin cn pancreatic exocrine function and insulin secretion stimulated with pancreozymin and secretin was determined. In all 7 patients with CRP the volume of pancreatic juice and the bicarbonate and amylase and protein output after stimulation were lower than in healthy subjects, and somatostatin had a reduced inhibitory effect on both the basal secretion and particularly on the pancreozymin-secretin-stimulated secretion. A similarly lower inhibitory effect of somatostatin on the secretin-pancreozymin induced increase in blood insulin (IRI) level was observed in these patients. The presented data suggest that the damaged pancreas reacts less effectively not only to the stimuli enhancing its exocrine and endocrine secretory activity, but also to the stimuli inhibiting this activity. This observation may be of practical value for the evaluation of the functional efficiency of the pancreas.

Topics: Adult; Amylases; Cholecystokinin; Chronic Disease; Duodenum; Female; Humans; Insulin; Intestinal Secretions; Male; Middle Aged; Pancreas; Pancreatitis; Secretin; Somatostatin

Topics: Cholecystokinin; Chronic Disease; Humans; Insulin; Pancreatic Function Tests; Pancreatic Juice; Pancreatitis; Secretin

Assessment of the clinical value of the pancreolauryl test (PLT) in the literature range from "useless" to a specifity of 95% and a sensitivity of 98%. In this work, our own data are presented in relation to various reference methods. The results are derived from the largest collective investigated to data, comprising 40 controls and 391 patients (108 with chronic pancreatitis and 283 with other gastrointestinal disorders). The specifity of the the PLT varies between 81% and 95% according to the "quality" of the control collective. The PLT is particularly frequently pathological in patients with diseases in the region of the gallbladder/bile duct and the gastrointestinal tract. The sensitivity of the PLT for chronic pancreatitis varies between 68% and 100%, depending on 9 different reference methods employed. Based on the prevalence of chronic pancreatitis with exocrine insufficiency in various patient collectives, the predictive value of the PLT for the presence of this disorder can be calculated using our data.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Cholelithiasis; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Exocrine Pancreatic Insufficiency; Gastrointestinal Diseases; Humans; Liver Diseases; Pancreatic Diseases; Pancreatic Function Tests; Pancreatitis; Secretin; Tomography, X-Ray Computed

The diagnosis of chronic pancreatitis is often difficult to establish and may involve invasive diagnostic procedures. Serum pancreatic isoamylase has been estimated by the inhibitor method in controls and in 38 patients with known chronic pancreatitis in order to evaluate its use as a diagnostic test. The mean pancreatic isoamylase in those with chronic pancreatitis (68 +/- 77 IU/l) was significantly lower (p less than 0.005) than in controls (113 +/- 60 IU/l). The diagnostic sensitivity of pancreatic isoamylase was 50% (compared to total amylase 9%) and had a specificity of 95%. Stimulation tests with cholecystokinin and secretin failed to increase the sensitivity of the test. A low value of pancreatic isoamylase strongly supports a diagnosis of chronic pancreatitis and may obviate the need for further investigation.

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Female; Glycoside Hydrolases; Humans; Isoamylase; Male; Middle Aged; Pancreas; Pancreatitis; Reagent Kits, Diagnostic; Secretin; Stimulation, Chemical; Time Factors

Topics: Adolescent; Adult; Cholecystography; Cholecystokinin; Chronic Disease; Female; Gallbladder Diseases; Humans; Male; Middle Aged; Radionuclide Imaging

The pancreatic polypeptide (PP) release after a standard meal and the PP release and the pancreatic secretion of bicarbonate and amylase after stimulation by secretin GIH, 1 CU kg-1 intravenously, and by cholecystokinin (CCK), 1 Ivy dog unit kg-1 intravenously, have been investigated in 10 patients with chronic pancreatitis. Significant correlations were found between the integrated PP responses after food and hormonal stimulation (p less than 0.05), between the integrated PP response and the peak serum PP concentration after food (p less than 0.01) and after secretin/CCK (p less than 0.01), and between the peak serum PP concentrations obtained after food, secretin, and CCK (p less than 0.01). The pancreatic outputs of bicarbonate and amylase and the peak amylase concentration after hormonal stimulation were significantly correlated (p less than 0.01), but no significant correlation was found between any one of these variables of exocrine pancreatic function and the PP release. It is concluded that, in chronic pancreatitis, food, secretin, and CCK stimulate PP release similarly and that no correlation can be established between the PP release and the exocrine pancreatic secretion.

Topics: Adult; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Female; Food; Humans; Male; Middle Aged; Pancreatic Polypeptide; Pancreatitis; Secretin

Topics: Animals; Apomorphine; Behavior, Animal; Brain; Bucladesine; Ceruletide; Cholecystokinin; Chronic Disease; Dopamine; Humans; Rats; Rats, Inbred Strains; Schizophrenia; Species Specificity

The sensitivity and specificity of the pancreolauryl test was evaluated in comparison with the NBT-PABA test, the estimation of fecal chymotrypsin and fat, and the secretin-pancreozymin test in 168 patients with and without pancreatic disease. The overall sensitivity rate was as follows: pancreolauryl test 90%, NBT-PABA test 86%, fecal chymotrypsin 66%. In patients with pancreatic steatorrhea the sensitivity of the pancreolauryl test was 100%, the NBT-PABA test 97%, and the fecal chymotrypsin estimation 92%. The specificity of these tests was: pancreolauryl test 97.6%, fecal chymotrypsin 87%, and NBT-PABA test 81.8%. The pancreolauryl test may be recommended as a noninvasive easy-to-perform tubeless pancreatic function test with a sufficiently high sensitivity and specificity.

Topics: 4-Aminobenzoic Acid; Cholecystokinin; Chronic Disease; Chymotrypsin; Feces; Fluoresceins; Humans; Nitroblue Tetrazolium; Pancreatic Function Tests; Pancreatitis; Secretin

Topics: 4-Aminobenzoic Acid; Carbon Radioisotopes; Cholecystokinin; Chronic Disease; Humans; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Endoscopy; Humans; Pancreas; Pancreatic Function Tests; Pancreatic Juice; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Electrolytes; Endoscopy; Humans; Pancreatic Function Tests; Pancreatic Juice; Pancreatitis; Secretin; Trace Elements

Topics: Cholecystokinin; Chronic Disease; Eating; Humans; Pancreatitis

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreatic Function Tests; Pancreatitis; Secretin

Topics: Adolescent; Adult; Aged; Cholagogues and Choleretics; Cholecystitis; Cholecystokinin; Cholelithiasis; Chronic Disease; Female; Humans; Kinins; Male; Middle Aged

The results of the secretin-pancreozymin test, duodenal aspirate cytology and hypotonic duodenography (the Triple Test), performed during a single duodenal intubation in patients with pancreatic or ampullary carcinoma, chronic pancreatitis and non-pancreatic disease were analysed retrospectively. Thirty-five of 36 carcinoma patients and all 11 chronic pancreatitis patients had an abnormal result. One hundred and sixteen of 170 non-pancreatic disease patients had a normal result. It would appear that the Triple Test (TT) may be a useful screening test for pancreatic disease.

Topics: Cholecystokinin; Chronic Disease; Duodenum; Humans; Intestinal Secretions; Intubation, Gastrointestinal; Pancreatic Diseases; Pancreatic Function Tests; Pancreatic Neoplasms; Pancreatitis; Radiography; Retrospective Studies; Secretin

Thirty percent of alcoholic patients without clinical evidence of pancreatic or hepatic disease showed hypersecretion of pancreatic bicarbonate in all three test periods after stimulation with secretin and secretin-cholecystokinin, and an increased amount of protein in the duodenal aspirate of the first test period, probably due to ductal wash-out. This hypersecretion must be taken into account when the secretion or secretin-cholecystokinin tests of alcoholics are interpreted, and, indeed, may be useful in identifying possible early pancreatic dysfunction that precedes insufficiency and clinical symptoms.

Topics: Adult; Alcoholism; Bicarbonates; Brazil; Cholecystokinin; Chronic Disease; Female; Humans; Intestinal Secretions; Male; Pancreas; Pancreatic Function Tests; Pancreatitis; Proteins; Secretin

Topics: Acute Disease; Adenocarcinoma; Carcinoma; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Humans; Insulinoma; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin; Time Factors; Zollinger-Ellison Syndrome

Topics: Amylases; Animals; Carbachol; Cholecystokinin; Chronic Disease; Enzyme Precursors; Female; Microscopy, Electron; Pancreas; Pancreatic Juice; Pancreatitis; Secretin; Sheep; Stimulation, Chemical; Water

Topics: Adolescent; Adult; Celiac Disease; Cholecystokinin; Chronic Disease; Female; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatic Polypeptide; Pancreatitis; Pentagastrin; Peptide Fragments; Secretin; Sincalide; Trypsin

1. According to a currently popular biological hypothesis schizophrenic symptoms are caused by a hyperactivity in dopaminergic neurotransmission. Since cholecystokinin (CCK) is a neuromodulator of dopaminergic neurotransmission, the effects of CCK (0.3 microgram/kg; given in a single dose intravenously) were studied in six chronic paranoid schizophrenic patients. 2. Following 3 baseline assessments on separate days, the effects of CCK treatment were assessed immediately after the injection, daily for one week and weekly thereafter for 5 weeks by the Brief Psychiatric Rating Scale (BPRS) and by the Schizophrenia Subscale of the Present State Examination (SS-PSE). 3. One way analysis of variance revealed statistically significant changes in all BPRS factors as well as in the nuclear syndrome and in the total score of the SS-PSE. Dunnett's tests revealed that the time at which the changes from baseline became statistically significant was as follows: anxiety-depression factor of the BPRS, immediately after the injection; anergia factor of the BPRS, by day 2; thought disturbance factor of the BPRS, immediately after; activation factor of the BPRS, immediately after; hostile-suspiciousness factor of the BPRS, by day 1; total BPRS score, immediately after; nuclear syndrome of the SS-PSE, by day 1; and total score of the SS-PSE, by day 1. 4. It is concluded that further controlled studies of the antipsychotic properties of CCK are warranted.

Topics: Adult; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

The changes of plasma pancreatic polypeptide (PP) and the relationship between PP response and exocrine pancreatic function in chronic pancreatitis are reported. In 260 healthy control subjects, plasma PP levels increased gradually with aging. Basal levels of PP in 30 patients with chronic pancreatitis were significantly lowered in comparison with age matched control subjects (control 95.0 +/- 10.3 pg/ml, chronic non-calcifying pancreatitis 45.0 +/- 7.3 pg/ml, chronic calcifying pancreatitis 40.4 +/- 6.0 pg/ml). Plasma PP response by insulin induced hypoglycemia, test meal ingestion, and pancreozymin-secretion represented a significant decrease in patients with chronic pancreatitis. Additionally, maximum PP response, especially in pancreozymin-secretin injection, had a good correlation with exocrine pancreatic function. These results suggest that the determination of plasma PP response is useful for the diagnosis of chronic pancreatitis.

Topics: Adult; Age Factors; Aged; Blood Glucose; Cholecystokinin; Chronic Disease; Eating; Fasting; Female; Humans; Insulin; Male; Middle Aged; Pancreatic Function Tests; Pancreatic Polypeptide; Pancreatitis; Secretin

Forty-five patients with chronic pancreatitis (of whom only 14 had pancreatic calculi) were investigated by endoscopic pancreatography and the secretin-pancreozymin test in order to explore the relationship between exocrine function and duct morphology in this disease. Each pancreatogram was assigned a score that ranged from 1 when the duct system was normal to 6 when a chain-of-lakes replaced the main duct; the scores attained were compared with the respective secretory volumes, bicarbonate concentrations, bicarbonate outputs, and trypsin outputs of exocrine secretions. Although a significant negative correlation emerged in each instance, the secretory overlap between the six subgroups was so marked as to render impractical any prospect of accurately predicting the pancreatogram appearance on the basis of prevailing pancreatic function in any individual case, or vice versa. The likely explanation for this result is that (a) chronic pancreatitis is a patchy process in which the acini and ducts are variably affected, and (b) destruction of parenchyma and obstruction to drainage of secretions contribute in varying proportions to the decrease in exocrine function.

Topics: Bicarbonates; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatic Ducts; Pancreatitis; Secretin; Trypsin

Topics: Adult; Antipyrine; Biotransformation; Cholecystokinin; Chronic Disease; Diabetes Mellitus; Hepatitis; Humans; Liver; Metabolic Clearance Rate; Pancreatitis

Topics: Adult; Cholecystitis; Cholecystokinin; Chronic Disease; Female; Humans; Longitudinal Studies; Male; Middle Aged; Pancreas; Pancreatitis; Recurrence; Remission, Spontaneous

Topics: Cholecystokinin; Chronic Disease; Humans; Middle Aged; Pancreatic Function Tests; Pancreatitis; Secretin; Ultrasonography

Synthesis of pancreatic enzymes was measured in 7 patients with chronic pancreatitis and 10 patients with no pancreatic disease, on the basis of the incorporation of 75Se-methionine into pancreatic exocrine proteins. Two of the patients with chronic pancreatitis had normal exocrine function. Pancreatic secretion was stimulated by intravenous infusion of secretin (1 clinical unit x kg-1 x h-1) and cholecystokinin (1 Ivy dog unit x kg-1 x h-1). 75Se-methionine (3.0 microCi x kg-1) was added to the infusion. Synthetic rates were significantly greater in all the patients with chronic pancreatitis, including the two individuals with normal responses to stimulation with secretin and cholecystokinin. Studies of synthetic rates may therefore be able to confirm the diagnosis of chronic pancreatitis before exocrine insufficiency becomes manifest.

Topics: Adolescent; Adult; Aged; Cholecystokinin; Chronic Disease; Female; Humans; Male; Methionine; Middle Aged; Pancreas; Pancreatitis; Protein Biosynthesis; Radioisotopes; Secretin; Secretory Rate; Selenium; Stimulation, Chemical; Trypsin

In 72 patients with chronic pancreatitis results of tbe secretin-cholecystokinin test were compared with those of several indirect test of pancreatic function (faecal fat content, chymotrypsin activity in faeces, peptide-PABA test, fluorescein-dilaurate test and weight of faeces). In 46 patients with markedly impaired pancreatic secretion the indirect tests were abnormal in 56-83% of cases. In 26 patients with normal or upper-limit-of-normal excretory function the same tests were abnormal in 15-77%. These results indicate that indirect tests of pancreatic function are of only limited value in the early diagnosis of pancreatic insufficiency.

Topics: Adult; Cholecystokinin; Chronic Disease; Exocrine Pancreatic Insufficiency; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; Secretin

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatitis; Secretin; Ultrasonography

Topics: Amylases; Cholecystokinin; Chronic Disease; Humans; Lipase; Pancreas; Pancreatitis; Pentagastrin; Stimulation, Chemical; Trypsin

The effect of 3-week CCK-OP treatment on test meal stimulated pancreatic secretion was investigated in chronic pancreatitis patients. One drop of a 1 mg/ml CCK-OP solution applied intranasally, three times daily during 3 weeks resulted in a significant increase in volume, trypsin, lipase and amylase secretion in response to the Lundh test meal. Augmentation of trypsin secretion was the most pronounced. Functional capacity of pancreatic enzyme secretion remained elevated for 3 months after treatment. Nearly all patients became symptom free during and for some time after treatment. The results were attributed to a trophic effect of CCK-OP on human pancreas.

Topics: Administration, Intranasal; Adult; Cholecystokinin; Chronic Disease; Diet; Female; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Sincalide

A comparative evaluation of ERCP and the bicarbonate output 30 min after stimulation of the pancreas with secretin and cholecystokinin-pancreozymin, was carried out in 124 patients, of whom 65 were affected by proven chronic pancreatitis (PCP), and 59 by only suspected chronic pancreatitis (SCP). In PCP patients the false negative results were 14.7% and 21.5%, respectively. In 5 of the PCP patients with false negatives on ERCP and functional test a normal result of both the procedures was found. ERCP and bicarbonate output were found to be abnormal in 12% and 40%, respectively of 59 patients with SCP. In 30 SCP subjects both procedures gave a normal result, and only in two cases were results abnormal. A correct classification of the SCP patients with pathological bicarbonate secretion and normal ERCP seems quite impossible. The diagnostic usefulness of ERCP results is preeminent but the of carrying out both types of investigation together may give complementary information in the evaluation of pancreatic disorders.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; False Negative Reactions; Humans; Pancreatic Function Tests; Pancreatitis; 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

Topics: Adult; Cholecystokinin; Chronic Disease; Copper; Duodenum; Humans; Intestinal Secretions; Middle Aged; Pancreatitis; Secretin

The diagnostic value of the fecal chymotrypsin test (FCT) was reevaluated with regard to (a) proved pancreatic hypofunction of different severity (183 pancreozymin-secretin tests); (b) the final clinical diagnosis, and (c) fecal fat excretion (208 patients with chronic pancreatitis; CP). Progressive pancreatic disease (cancer, CP) was mainly associated with moderate or severe pancreatic hypofunction (119/138; 86.2%) and a low incidence of false-normal FCT values (14/138; 10.1%). Miscellaneous disorders (mainly reversible pancreatic hypofunction) were mainly associated with slight pancreatic hypofunction and a high incidence of false-normal FCT values (17/45; 37.8%). Pancreatic steatorrhea (greater than 10 g/day) was found only in patients with markedly depressed FCT values. Progressive deterioration of pancreatic function was demonstrated by repeated FCT in CP (n = 220).

Topics: Celiac Disease; Cholecystokinin; Chronic Disease; Chymotrypsin; Exocrine Pancreatic Insufficiency; False Negative Reactions; Feces; Humans; Lipids; Pancreatic Function Tests; Pancreatitis; Secretin

Calcium, enzyme, and total protein secretion were measured in secretin stimulated pancreatic juice in health, "early" chronic pancreatitis, and in chronic calcific pancreatitis. Increased concentrations of trypsin, total protein, and calcium, and increased outputs of calcium and protein were shown to be present in the "early" stages of the disease, indicating that an environment conducive to the formation of protein plugs and possibly later calcification already exists.

Topics: Calcium; Cholecystokinin; Chronic Disease; Duodenum; Humans; Intestinal Secretions; Pancreatitis; Proteins; Secretin; Trypsin

Topics: Biliary Tract Diseases; Child; Cholecystitis; Cholecystokinin; Chronic Disease; Enzyme Activation; Humans; Pancreas; Secretin

Changes in the radiological diagnosis of gallbladder disease are occurring at a remarkable rate. In this symposium, several recognized authorities place the various diagnostic modalities and their interrelation in modern perspective. The present and future roles of oral cholecystography and intravenous cholangiography, the radiological diagnosis of chronic acalculous cholecystitis, and the use of ultrasonography and cholescintigraphy are analyzed.

Topics: Acute Disease; Cholangiography; Cholecystitis; Cholecystography; Cholecystokinin; Chronic Disease; Gallbladder Diseases; Humans; Imino Acids; Radionuclide Imaging; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Lidofenin; Tomography, X-Ray Computed; Ultrasonography

Pancreas exocrine secretion in 45 patients with chronic alcoholism was studied. Pancreocimene-secretion test was carried out in all of them, with the determination of pancreas secretion, concentration of bicarbonate excreted, amount of the secreted bicarbonates and a total quantity of the secreted diastase and lipase. Serum provocative test was carried out in parallel. The results were compared with the control group of 30 healthy subjects. Disturbed pancreas secretion was found in 57,7 per cent of the subjects examined, the volume of secretion being reduced in 37,7 per cent of the patients, bicarbonate secretion--in 44 percent; amount of secreted bicarbonates--in 51,1 per cent, quantity of secreted lipase--in 57,7 per cent and diastase--in 51,1 per cent of the patients. The discrepancies with the control group are statistically significant. In 42,2 per cent of the examined--positive provocative test was established. Hypersecretion of liquids and bicarbonates was found in 13,3 per cent of the patients. The severity of the changes in pancreas secretion depends on the amount and duration of alcohol consumption.

Topics: Adult; Alcoholism; Cholecystokinin; Chronic Disease; Humans; Male; Pancreas; Pancreatitis; Secretin

Plasma pancreatic polypeptide (PP), a newly recognized pancreatic hormone, was studied in healthy subjects and patients with chronic pancreatitis. After an oral load of 50 g of meat extract, the plasma concentration of PP showed a rapid fourfold rise at 20 min in healthy controls. In contrast, the plasma PP level rose only 1.8-fold in patients with chronic pancreatitis. This difference was statistically significant (P less than 0.05). The increase rate of the PP level during the test in each subject correlated significantly (P less than 0.01) with total amylase output and maximal amylase concentration measured by the pancreozymin-secretin test. Thus, it is suggested that the measurement of the plasma PP level may be a useful tool to diagnose chronic pancreatitis.

Topics: Adult; Aged; Animals; Cholecystokinin; Chronic Disease; Female; Hormones; Humans; Male; Meat; Middle Aged; Pancreatic Function Tests; Pancreatic Polypeptide; Pancreatitis; Secretin; Tissue Extracts

Saliva secretion was studied via pilocarpine test in 40 patients with pancreas exocrine insufficiency: 32 patients with chronic pancreatitis and 8 patients with pancreas carcinoma. After pilocarpine stimulation, the volume of saliva secretion was determined in ml., as well the concentration and quantity of the secreted bicarbonates, amylase and protein. The results were compared with a control group of 17 healthy subjects. Statistically significant diminution of all indices of saliva secretion was found in the patients with pancreas exocrine insufficiency (p less than 0.001). The correlation relationship between the changes of pancreas and saliva secretion was studied. Saliva secretion could be used as orientating test for the presence of pancreas exocrine insufficiency.

Topics: Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Pilocarpine; Saliva; Salivary Glands; Secretin

The classification of accumulative patterns with the pancreatic scintigram findings of chronic pancreatitis and carcinoma of the pancreas were compared with endoscopic retrograde pancreatography (ERP) findings and Pancreozymin-Secretin test (P-S test). I) The frequency of pancreatic cancer was 93%, whilst, the chronic pancreatitis was 88% in the abnormal pancreatic scintigram. II) In the scintigram the type II (localized defect shadows) of pancreatic cancer was comparatively high and it is proportional to evidence derived from ERP. Localized diagnostic certainty is helpful, although the two tests are related. The P-S test is only restricted to the carcinoma of head, whilst, scintigram is more useful to detect the carcinoma of the body and tail of the pancreas. II) As for the chronic pancreatitis, there are various accumulative patterns. This is resemblance to that of ERP findings, but in the P-S normal test, it showed discrepancy in part of the result. Particularly, in the type I (slightly generalized low uptake with density silhouette) and type II. Therefore in order to obtain an accurate diagnosis, it is essential to have both the P-S test and scintigram.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Evaluation Studies as Topic; Humans; Pancreas; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin

Topics: Acute Disease; Adult; Cholecystitis; Cholecystokinin; Chronic Disease; Cystic Duct; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Radionuclide Imaging

Topics: Amylases; Animals; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Digestive System Diseases; Dogs; Endopeptidases; Enzyme Activation; Humans; Hydrolases; Lipase; Pancreas; Secretin

Topics: Amylases; Cholecystokinin; Chronic Disease; Female; Humans; Male; Pancreas; Pancreatic Diseases; Pancreatitis; Saliva; Secretin; Stimulation, Chemical

Topics: Adult; Aged; Amylases; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Female; Humans; Isoenzymes; Male; Microscopy, Electron; Middle Aged; Pancreas; Pancreatitis; Secretin

Cyclic AMP (cAMP) output in the duodenal contents of 11 normal subjects, 18 patients with chronic pancreatitis, six convalescing from acute pancreatitis and five with pancreatic carcinoma was measured after a single dose of pancreozymin and secretin. The technic was indirect, utilizing recovery of duodenal contents by the Dreiling tube rather than direct measurements of fluid that was not contaminated by bile. In all patients groups, cAMP output reached a peak after this stimulation with a concomitant increase of bicarbonate and amylase outputs. A significantly decreased cAMP output was observed in all pancreatic disease groups compared to the normal group. Patients with chronic pancreatitis showed a slightly decreased cAMP output, considerably decreased bicarbonate output and normal amylase output. In acute pancreatitis cAMP output was reduced with normal bicarbonate and amylase outputs. In pancreatic carcinoma cAMP decreased significantly, bicarbonate output was moderately reduced and amylase output was normal. cAMP output in all groups studied did not correlate with either bicarbonate output or amylase output.

Topics: Acute Disease; Adult; Aged; Cholecystokinin; Chronic Disease; Cyclic AMP; Duodenum; Hormones; Humans; Intestinal Secretions; Middle Aged; Pancreatic Function Tests; Pancreatic Neoplasms; Pancreatitis; Secretin

Established and modern methods for assessment of exocrine pancreatic function are reviewed and discussed with regard to diagnostic workup in chronic pancreatitis. Determination of chymotrypsin in stool or oral admit BT-PABA suffice as screening methods, while more sensitive methods such as Lundh test, secretin, or secretin/pancreozymin are suitable for confirmation of diagnosis.

Topics: 4-Aminobenzoic Acid; Cholecystokinin; Chronic Disease; Chymotrypsin; Feces; Humans; Pancreatitis; Secretin

The NBT-PABA test, an oral pancreatic function test, was performed in 67 patients with proven chronic pancreatitis (secretin pancreozymin test or intraoperatively) and was pathological in 60 (89.6%). Prolongation of urinary collection period from 6 to 9 hours did not improve the diagnostic value. In comparison with the NBT-PABA test the sensitivity of trypsin and chymotrypsin determination in stool was 40.6% and 62.2%, respectively. In severe exocrine pancreatic insufficiency when pathological fecal fat excretion was demonstrable (steathorrhea) the accuracy of fecal enzyme determination was clearly higher (59.1% and 91.8%, respectively). Thus the NBT-PABA test is an alternative diagnostic tool for exocrine pancreatic insufficiency when the secretin-pancreozymin test, and fecal enzyme and fecal fat determination are too complicated. However, as intact absorption of NBT-PABA is possible, the test only provides a qualitative and limited quantitative evaluation of pancreatic function.

Topics: 4-Aminobenzoic Acid; Adolescent; Adult; Aged; Aminobenzoates; Cholecystokinin; Chronic Disease; Exocrine Pancreatic Insufficiency; Feces; Female; Humans; Lipids; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Secretin

Exocrine pancreatic function, as revealed by bicarbonate output after secretion stimulation and trypsin output after CCK stimulation, fecal fat excretion, and glucose tolerance were studied in 40 patients with pancreatitis. A high fecal fat excretion and an abnormal glucose tolerance were found in about three quarters of the patients with markedly reduced bicarbonate output (less than 0.15 mmol . h-1 . kg-1). Normal fecal fat excretion was observed in five of six and normal glucose tolerance in all patients who had a normal bicarbonate output (greater than 0.30 mmol . h-1 . kg-1). All of the patients with abnormal glucose tolerance had impaired bicarbonate output. The trypsin output after CCK stimulation was not more closely related either to the fecal fat excretion or to the glucose tolerance.

Topics: Adult; Aged; Blood Glucose; Cholecystokinin; Chronic Disease; Dietary Fats; Fatty Acids; Feces; Female; Glucose Tolerance Test; Humans; Male; Middle Aged; Pancreas; Pancreatic Function Tests; Pancreatitis; Recurrence; Secretin

The coexistence of nontropical sprue and advanced pancreatic insufficiency is uncommon. The purposes of this report are to: (a) describe 3 patients with non-tropical spruc and severe pancreatic insufficiency, (b) determine the frequency, magnitude, and clinical importance of diminished pancreatic secretion in nontropical sprue, and (c) assess whether patients with pancreatic insufficency secondary to chronic pancreatitis or pancreatic cancer have jejunal mucosal histologic abnormalities. In each of 3 patients with nontropical sprue and associated severe exocrine pancreatic insufficiency, an optimal clinical response required the appropriate treatment of both causes of malabsorption. Of 31 subjects with proved nontropical sprue, cholecystokinin-stimulated duodenal tryptic activity or lipolytic activity (or both) was reduced in 13 (42%) but severely reduced in only the three case reports (10%). The morphologic structure of the small bowel was normal in 21 patients with primary pancreatic insufficiency secondary to chronic pancreatitis or pancreatic cancer. Mild-to-moderate exocrine pancreatic insufficiency is a frequent finding in untreated nontropical sprue, is presumably reversible, and rarely contributes to the development of steatorrhea. However, if patients with nontropical sprue fail to respond to a gluten-free diet, coexistent severe pancreatic insufficiency is a possible cause for treatment failure.

Topics: Aged; Celiac Disease; Cholecystokinin; Chronic Disease; Female; Humans; Jejunum; Lipase; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Trypsin

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Duodenum; Humans; Intestinal Secretions; Lipase; Middle Aged; Pancreatitis

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Deoxyribonucleases; Female; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Secretin

Topics: Bile; Biliary Tract Diseases; Cholecystokinin; Chronic Disease; Humans; Liver; Liver Diseases

Serum immunoreactive trypsin (IRT) determination has been recommended as a screening test in chronic pancreatitis. Using a commercial radioimmunoassay kit (RIA--gnost Trypsin; Behring-Werke, Marburg/Lahn, FRG) the interassay coefficient of variation was 26--44% for three different test sera. Gel filtration chromatography profiles revealed immunoreactivity in the position of 125I-trypsin and (less than 50%) in the void volume. The test was evaluated in controls (n = 90), chronic relapsing pancreatitis (CRP;n = 60) and after total pancreatectomy (n = 5). In 65% of the CRP cases decreased IRT values were found, whereas during acute attacks of CRP supranormal and normal values were found. After total pancreatectomy IRT levels were undetectable. It is concluded that the sensitivity of this IRT test is limited and that the available test system needs improvement.

Topics: Cholecystokinin; Chromatography, Gel; Chronic Disease; Humans; Pancreatectomy; Pancreatitis; Radioimmunoassay; Recurrence; Trypsin

The authors have performed successively endoscopic retrograde pancreatography (ERP) and secretin-pancreozymin test (SPT) 104 times. A good correlation between ERP und SPT was demonstrated in 84.6%: 50% of patients with pathologic pancreatogram showed also an abnormal pancreatic function test while 36 (34.6%) out of 104 examinations demonstrated both normlal ERP und SPT. A discrepancy between both procedures was found only in 15.4%: pathologic ERP and normal SPT (9.6%) and reversal (5.8%). In conclusions, ERP and pancreatic function tests appear complementary to each other in the evaluation of pancreatic disorders.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Humans; Pancreatic Diseases; Pancreatic Function Tests; Pancreatitis; Secretin

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

Topics: Adolescent; Child; Child, Preschool; Cholecystokinin; Chronic Disease; Digestive System Diseases; Humans; Hydrochloric Acid; Pancreas; Pancreatic Diseases; Secretin

Pancreas scintigraphy with 75selenomethionine, pancreocimine-secretin test and selective abdominal angiography was carried out in patients with chronic pancreatitis, pancreas carcinoma and subjects without any pancreas diseases. Scintigraphic changes in pancreas were found in 95.6 per cent of the patients with chronic pancreatitis (136 patients) in 92 per cent of them with pancreas carcinoma (25 patients) and in 53.4 per cent from the subjects without pancreas diseases (30 examined). Pathological changes in pancreatic secretion was found in 93.4 per cent of the patients with chronic pancreatitis (105 patients) in 93.8 per cent of the subjects with pancreas carcinoma (32 patients) and only in 3.3 per cent from the examined without pancreatic diseases. The angiographic examination is informative mainly in case of tumours and cysts of the pancreas. The diagnostic potentialities of the separate methods for pancreas examination were critically assessed. The basic diagnostic problems, in pancreas diseases are solved to a great extent with the combined examination with scintigraphy, pancreocimine-secretin test and angiography (76 patients).

Topics: Angiography; Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin; Selenomethionine

The relationship between insulin responses to oral glucose and pancreatic exocrine function were examined in 15 patients with chronic pancreatitis. Good correlations were found between the insulin responses and exocrine pancreatic function measured as the concentrations of pancreatic enzymes in duodenal juice after intravenous cholecystokinin-pancreazymin (CCK-PZ). There appears to be a roughly parallel loss of endocrine and exocrine function in the course of chronic pancreatitis.

Topics: Administration, Oral; Adult; Cholecystokinin; Chronic Disease; Duodenum; Female; Glucose; Humans; Injections, Intravenous; Insulin; Insulin Secretion; Intestinal Secretions; Male; Middle Aged; Pancreas; Pancreatitis

A study on the diagnostic value of the parotid and mixed saliva assay after stimulation with 1% pilocarpine hydrochloride was carried out in 36 controls and 26 patients affected with chronic pancreatitis. No statistical difference between the two groups was found as far as saliva volume, bicarbonate and amylase (concentration and output) are concerned. No correlation was found between the results of the saliva test and those of the secretin-pancreozymin test or endoscopic retrograde pancreatography. These data excluded any diagnostic role of the saliva test in chronic pancreatitis.

Topics: Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatitis; Parotid Gland; Pilocarpine; Radiography; Saliva; Secretin; Secretory Rate

Topics: Alcoholism; Cholecystokinin; Chronic Disease; Female; Humans; Male; Pancreatic Juice; Pancreatitis; Proteins; Secretin

Topics: Adolescent; Adult; Aged; Cholecystokinin; Chronic Disease; Duodenum; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Neoplasms; Secretin; Thailand

Endoscopic retrograde pancreaticography (ERP) and secretin-pancreozymin test corrected for losses (SP test) were performed in 153 patients suspected to have pancreatic disorders in order to evaluate diagnostic significance of these procedures. Pancreatic sonography was done in addition in 110 of these patients. If pancreatic excretion was normal, ERP results turned out to be normal in the same patients as well. SP test involves rather extensive laboratory work-up, but it does yield the most precise results as far as diagnosis of chronic pancreatitis is concerned. For this reason, and because of the possible complications caused by ERP, ERP should be applied only, when surgery is considered. Results of SP test and sonography coincided rather well. Therefore, sonography, not doing any harm to the patient, does have its place in the diagnosis of chronic pancreatitis.

Topics: Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Endoscopy; Humans; Methods; Pancreatitis; Radiography; Secretin; Ultrasonography

The nature and extent of enkephalin- and morphine-induced inhibition of pancreatic bicarbonate and protein secretion were studied in dogs with chronic pancreatic fistulae after administering exogenous secretin or octapeptide of cholecystokinin and stimulants for the endogenous release of these hormones. Enkephalin and morphine competitively inhibited the pancreatic bicarbonate secretion induced either by exogenous secretin or duodenal acidification. This inhibition was partially reversed by naloxone, an opiate antagonist. Opiate substance also profoundly inhibited pancreatic protein response to octapeptide of cholecystokinin and to various stimulants of endogenous cholecystokinin release. We conclude that enkephalin and morphine strongly inhibit the pancreatic responses to exogenous and endogenous stimulants by a mechanism involving separate opiate receptors.

Topics: Animals; Bicarbonates; Cholecystokinin; Chronic Disease; Depression, Chemical; Dogs; Dose-Response Relationship, Drug; Duodenum; Endorphins; Enkephalins; Hydrogen-Ion Concentration; Morphine; Naloxone; Pancreas; Peptides; Proteins; Receptors, Opioid; Secretin

The increase of serum gamma-GT after hormonal stimulation has been reported as a new provocative test in the diagnosis of chronic pancreatitis. The test was suggested to be more sensitive than the serum amylase provocation test. In a clinical study of both tests in 83 consecutive patients the unsensitivity and the high rate of false positive results were demonstrated. Thus these provocation tests do not seem to be valuable in the diagnosis of chronic pancreatitis.

Topics: Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; gamma-Glutamyltransferase; Humans; Pancreatitis; Secretin; Secretory Rate; Stimulation, Chemical

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatic Juice; Pancreatitis; Peptic Ulcer; Stimulation, Chemical

A new test using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (N-BT-PABA) for an evaluation of exocrine pancreatic function was compared with a pancreozymin-secretin test in 38 subjects. Urinary recovery of PABA, which is absorbed from the intestine and conjugated in the liver after an oral administration of N-BT-PABA, depends mainly on chymotrypsin activity. The recovery rate of PABA in urine decreases in chronic pancreatitis, in which chymotrypsin activity in the duodenal juice is disturbed. The recovery rate of PABA in calcifying chronic pancreatitis was 40.2 +/- 15% and significantly less than 81.2 +/- 7.4% in normal subjects (P less than 0.01). The amount of PABA in urine during eight hours was correlated with parameters of volume output- bicarbonate concentration and amylase output stimulated by injections of pancreozymin and secretin (P-S test). The new test using N-BT-PABA is useful for the evaluation of exocrine pancreatic function in general practice.

Topics: 4-Aminobenzoic Acid; Adult; Aged; Aminobenzoates; Cholecystokinin; Chronic Disease; Female; Humans; Male; Methods; Middle Aged; Pancreatitis; para-Aminobenzoates; Secretin

The effect of glucagon infusion on secretin and combined secretin and cholecystokinin stimulated exocrine pancreatic secretion was studied in normal subjects and in patients after acute and with chronic pancreatic disease. Glucagon inhibited pancreatic protein secretion and had no inhibitory effect on volume or bicarbonate secretion.

Topics: Acute Disease; Bicarbonates; Blood Glucose; Cholecystokinin; Chronic Disease; Glucagon; Humans; Pancreas; Pancreatic Juice; Pancreatitis; Secretin; Secretory Rate

Topics: Cholecystokinin; Chronic Disease; Endoscopy; Humans; Methods; Pancreatic Ducts; Pancreatitis; Radiography; Secretin; Ultrasonography

An analysis of 89 cases with chronic pancreatitis revealed 56% of chronic alcoholic pancreatitis (AP). The sex ratio was 47 males to 3 females and the mean age at onset was 42.4 years in AP and 49.3 years in chronic non-alcoholic pancreatitis (NAP). The 'total amount' of alcohol consumption was correlated to the onset. In AP, the abdominal pain was apt to relapse and severe in nature, furthermore painless pancreatitis was seen in 6%. The association with diabetes or calcification (38%) were more frequently seen in AP. The calcifications in AP appeared to be smaller in size and distributed diffusely or localized in cephalic portion. A striking frequency of liver dysfunctions (39 cases) were demonstrated, however, cirrhosis was rare in AP. The P-S test dysunctions in NAP were frequently reversible in the follow up study, while even some of chronic asymptomatic alcoholics developed clinical signs of pancreatitis during the observed period and proceeded to definite AP, of whom pancreatic dysfunctions showed fluctuation and eventual progression. In other words, even pain free intervals the pancreatic inflammation in susceptible persons may proceed to ultimated destruction of the pancreas. The fatality from chronic pancreatitis was rare (12.3%), which was related diabetes mellitus.

Topics: Adult; Aged; Alcohol Drinking; Alcoholism; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreas; Pancreatitis; Secretin; Sex Factors

Topics: Absorption; Cholecystokinin; Chronic Disease; Hormones; Humans; Liver; Liver Circulation; Pancreatitis

The secretin-pancreozymin (SP) and Lundh-Borgström (meal) tests were compared in diagnosing chronic pancreatitis (CP). A range of normal values for each test was obtained in a control group of 22 patients without pancreatic disease. Seventeen patients with CP were given the tests on separate days. The peak concentration of bicarbonate after secretin was reduced in 14 of these 17 patients, post-secretin bicarbonate output fell in 13, while peak tryptic activity (PTA) in duodenal juice after pancreozymin was below normal in 10; the overall incidence of abnormal results in SP tests was 88%. The mean tryptic activity (MTA) in a two-hour collection of duodenal juice after the test meal was reduced below normal in 16 of the 17 patients.In the control group PTA after pancreozymin was closely similar to MTA after the test meal, but in the patients with CP MTA was significantly less than PTA. PTA and MTA correlated significantly in both the control and CP groups, and the slopes of the two regression lines were not significantly different. In each patient with CP the tryptic response to the test meal was only a third of the tryptic response to intravenous pancreozymin. This disproportionate reduction in tryptic response to endogenous compared with exogenous stimulation in CP accounts for the high success rate of the meal test, which equalled the SP test.The Lundh-Borgström test is a sensitive indicator of CP and is within the resources of most hospitals. The SP test is better suited to specialist centres and may provide valuable additional information in individual cases.

Topics: Bicarbonates; Cholecystokinin; Chronic Disease; Food; Humans; Pancreatitis; Secretin; Stimulation, Chemical; Trypsin

Simultaneous data of the pancreozymin-secretin test and the pancreatic excretion test with 5,5-dimethyl-2,4-oxazolidinedione DMO) were reported for 50 patients with chronic pancreatitis. The pancreozymin-secretin test was abnormal in 90% of the patients, while the pancreatic DMO excretion test showed abnormality in 100% of the patients. The dynamic process of pancreatic excretory dysfunction is discussed. Over 60% of patients with low to moderate grade chronic pancreatitis showed a discordant pattern of decreased DMO output with normal bicarbonate concentration or normal volume flow. Approximately 96% of patients with advanced grade chronic pancreatitis had a excretory pattern of decreased DMO output with low bicarbonate concentration and decreased volume flow. These findings may further develop a barrier hypothesis in chronic pancreatitis. In the early stage of chronic pancreatitis, when functional capacity of the duct is preserved fairly well, the extraductal barrier to the rapid DMO diffusion into the ducts (diffusion barrier) may be primarily responsible for impaired pancreatic DMO excretion. With progression of chronic pancreatitis, the intraductal barrier (outflow barrier) may become pronounced and precipitate pancreatic excretory dysfunction for DMO. The concept of pancreatic barriers may well serve to systematize major histologic alterations observed in chronic pancreatitis.

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Dimethadione; Female; Humans; Male; Methods; Middle Aged; Oxazoles; Pancreas; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreatic Juice; Pancreatitis; Secretin; Ultrasonography

Topics: Cholecystokinin; Chronic Disease; Diabetes Mellitus; Glucagon; Humans; Insulin; Male; Pancreatitis; Secretin

Topics: Administration, Intranasal; Cholecystokinin; Chronic Disease; Drug Evaluation; Humans; Pancreatitis

Topics: Cholecystokinin; Chronic Disease; Duodenum; Feces; Glucose Tolerance Test; Humans; Pancreatitis; Secretin; Starch

Role of ERCP in the diagnosis of inflammatory lesions of the pancreas was evaluated and following conclusions were obtained. 1) Following criteria were considered to be practical for clinical diagnosis of chronic pancreatitis by ERCP; a) More than moderate irregularity or rigidity of margin, dilatation, or irregularity in caliber of PDS, whether extensive or localized, or b) Cyst formation or c) Obstruction of PDS. These criteria permit to diagnose 100% of pancreatolithiasis, 82% of chronic pancreatitis without pancreatolithiasis and 64% of histologically diagnosed chronic pancreatitis but about 13% of "false positive results" must be taken into consideration. 2) ERCP plays an important role in detecting and locating localized or scattered lesions without noticable abnormalities in P-S test. It is also useful in deciding an indication for surgical intervention. However, it has limitations in detecting minimal to moderate pancreatitis. Some of these cases are often picked up by P-S test. 3) Combined approach with ERCP and P-S test is required for diagnosis of inflammatory lesions of the pancreas and either one is incomplete by itself.

Topics: Calculi; Cholangiography; Cholecystokinin; Chronic Disease; Endoscopy; Humans; Pancreas; Pancreatitis; Secretin

There is no agreement in the literature as regards the carrying out of the Secretin-Pancreozymin test in order to achieve the greatest accuracy in the diagnosis of pancreatic insufficiency. In this study the results obtained by bolus i.v. injection of Secretin and Pancreozymin GIH are compared with those obtained by i.v. infusion of the hormones. The test - always prolonged for one hour - was done in 125 subjects, divided into two groups matched for sex, age and pancreatic or digestive disease. Volume, pH, bicarbonates, calcium and amylase were measured in the juice collected. The results showed that bolus i.v. injection of Secretin and Pancreozymin has greater diagnostic sensitivity (94%) than the infusion method (84%). If infusion is used, it is necessary to protract the test for more than one hour.

Topics: Adult; Cholecystokinin; Chronic Disease; Drug Synergism; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreatic Juice; Pancreatitis; Secretin; Secretory Rate

Now that the active fragment of the cholecystokinin molecule has been made available for use in clinical pracitce, reports on the value of cholecystokinin cholecystography must be re-evaluated to determine if the procedure is worthwhile in patients with persistent symptoms and a normal conventional oral cholecystogram. Such an analysis discloses that there is no uniform agreement on what consitutes an abnormal examination and raises serious questions concerning the scientific validity of much of the data. It is apparent that there is no immutable evidence to date to indicate that cholecystokinin cholecystography is an accurate technique to determine which patients in this category will benefit from cholecystectomy.

Topics: Adolescent; Adult; Biliary Tract Diseases; Cholecystectomy; Cholecystitis; Cholecystography; Cholecystokinin; Chronic Disease; Humans; Middle Aged

The effect of maximal doses of cholecystokinin and caerulein on lipase and chymotropsin concentrations were compared in large groups of patients with almost equal capacities of bicarbonate secretion. The responsiveness of the pancreas is, as a whole, higher with caerulein than with cholecystokinin, this feature being specially evident in patients with chronic calcifying pancreatitis.

Topics: Bicarbonates; Ceruletide; Cholecystokinin; Chronic Disease; Chymotrypsin; Duodenum; Humans; Lipase; Pancreas; Pancreatitis

Topics: Acute Disease; Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatic Hormones; Pancreatitis; Secretin; Trypsin

Fecal chymotrypsin determination and secretin-pancreozymin test with volume-loss corrected were carried out intra-individually on 57 clinically normal test subjects and 51 patients with chronic pancreatic disease. A good correlation could be established in every case between the chymotrypsin activity in stool and the chymotrypsin output in the duodenal aspirate. False-positive chymotrypsin activity was not to be found in healthy subjects. On the other hand, however, the chymotrypsin activity in stool compared with the result of the secretin-pancreozymin test was found to be false negative in 21% of all patients with chronic pancreatic disease (some or all parameters pathological). In patients with a clear deficiency in the exocrine function of pancreas (all parameters pathological) the chymotrypsin activity was nevertheless seen to be false-negative in only 9.9% of the cases. Thus the fecal chymotrypsin determination can be used as screening test for the clearly reduced pancreatic exocrine insufficiency.

Topics: Adult; Cholecystokinin; Chronic Disease; Chymotrypsin; False Negative Reactions; Feces; Female; Humans; Male; Pancreatitis; Secretin

Topics: Adult; Cholecystokinin; Chronic Disease; Female; Humans; Male; Methods; Middle Aged; Pancreatic Juice; Pancreatitis; Secretin; Zinc

Peritoneoscopic puncture of the gallbladder for transvesical cholecysto-cholangiography and for aspiration of bile for chemical and bacteriological analysis is performed rather rarely because of a seemingly high rate of complications. The risk however is low if an appropriate technique is used. In our series the gallbladder was punctured in 110 cases; a local peritonitis subsiding under conservative treatment occured as a complication in only one case. Peritoneoscopic puncture of the gallbladder is indicated in the following conditions: extrahepatic occlusion of the bile duct system of unknown origin, nonvisualization of the gallbladder during cholangiography, biliary dyskinesia, typical biliary colics with normal X-ray findings. In addition, gallbladder puncture should be done if any suspicion of gallbladder disease arises during peritoneoscopy. The procedure as well as technical variations for cholecysto-cholangiography and for X-ray investigation of the pancreatic duct system are described.

Topics: Bile; Cholangiography; Cholecystokinin; Cholelithiasis; Chronic Disease; Female; Hepatic Duct, Common; Humans; Laparoscopy; Male; Middle Aged; Pancreatic Neoplasms; Pancreatitis

We studied insulin responses to glucose with and without cholecystokinin-pancreozymin and aminophyllin infusions in normal, chronic pancreatitic and genetic (maturity-onset) diabetic subjects. Glucose was given alone as separate 5 and 10 g boluses followed by infusion at 250 mg/min. and 500 mg/min., respectively. Chronic pancreatitis patients and genetic diabetic patients had decreased Imax values, indicating a decreased insulin reserve. Sensitivity to glucose was normal in pancreatitic subjects, but the diabetic subjects had a raised G50 value, compatible with glucoreceptor dysfunction. Infusions of aminophyllin enhanced insulin responses (Imax) to glucose injection in normal subjects and to a lesser degree in pancreatitic subjects, but decreased sensitivity to glucose (increase in G50) in both groups. Although the Imax value in pancreatitic subjects was significantly lower than in the control subjects during the glucose plus aminophyllin infusion, the blood glucose concentration in the pancreatitic subjects was nonetheless decreased. This suggests that pancreatitic subjects have increased endogenous insulin sensitivity. Aminophyllin had no effect in diabetic subjects. Crude cholecystokinin-pancreozymin changed the shape of the glucose/insulin dose response curve in normal, pancreatitic and diabetic subjects. These findings further suggest that the defect in insulin secretion in pancreatitic subjects is partly situated at the cyclic adenosine monophosphate stage of insulin release. Crude cholecystokin-pancreozymin seems to affect insulin release at a point beyond the cyclic adenosine monophosphate stage.

Topics: Adult; Aminophylline; Cholecystokinin; Chronic Disease; Cyclic AMP; Diabetes Mellitus; Gastrointestinal Hormones; Glucose; Humans; Insulin; Insulin Secretion; Kinetics; Male; Middle Aged; Pancreatitis; Receptors, Drug

Enzymatic, functional and morphological test are used for the diagnosis of pancreatic diseases. The enzymatic tests-amylase is the enzyme activity most frequently investigated-are best suited to the diagnosis of acute diseases. In chronic inflammations of the pancreas the serum enzymes do not usually increase because of the destruction of the parenchyma. The provocation test with pancreozymin secretin is especially indicated in chronic diseases of the pancreas. Digestion and absorption are only disturbed in the late stages of the disease. It is important to investigate them to determine the necessary susbtitution therapy. No method should be used alone, only series of tests give satisfactory results.

Topics: Acute Disease; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Humans; Isoamylase; Monoacylglycerol Lipases; Pancreatic Diseases; Pancreatitis; Secretin

In order to study whether or not mucosubstance increases occur in the pancreatic juice of patients with chronic pancreatitis, hexosamine was measured in duodenal aspirates during the secretin phase (S-40) following pancreozymin-secretin stimulation in 16 normal subjects, 37 patients with chronic pancreatitis, 6 patients with alcoholism, 13 patients with gallstones, and 11 patients with peptic ulcer. The hexosamine concentrations in the pancreatic secretions showed a negative correlation with the bicarbonate concentrations and volume output. Rises in hexosamine concentration were seen in alcoholism and chronic pancreatitis, especially in alcoholic pancreatitis. This is probably intimately related with the repeated ingestion of large amounts of alcohol over long periods of time. Since high hexosamine values are noted in the relapsing type of chronic alcoholic pancreatitis, increases in viscosity due to mucosubstance increases in the pancreatic juice are probably related with the recurrence of acute attacks accompanying ductal stenosis or obstruction.

Topics: Alcoholism; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Duodenum; Hexosamines; Humans; Pancreatic Juice; Pancreatitis; Proteins; Secretin; Stimulation, Chemical

Topics: Acute Disease; Amylases; Cholecystokinin; Chronic Disease; Humans; Pancreatitis; Parotid Gland; Saliva; Secretin; Stimulation, Chemical

Endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 98 patients with unexplained abdominal pain or known pancreatitis with recurrent pain. Patients with jaundice were excluded from the study. In 38 patients with a clinical diagnosis of pancreatitis, the radiological findings on ERCP were graded according to the criteria of Kasugai et al. Advanced pancreatitis was found in 20 patients (52,5%), moderate changes in 7 (18,4%) and minimal-change pancreatitis in 6 (15,8%). ERCP had normal pancreatic function tests. In 35 patients investigated for unexplained abdominal pain, changes consistent with pancreatitis were found in 7, pancreatic carcinoma in 5, a duodenal ulcer in 2, gallstones in 1 and a duodenal tumour in 1. ERCP was normal in 19 patients. A comparison of the findings on ERCP and the standard secretin-cholecystokinin pancreatic function test was available in 52 patients. There was a good agreement between the two tests in the patients with advanced or moderate pancreatitis as revealed by ERCP, but less agreement in the patients with minimal-change pancreatitis. A few patients with clinical pancreatitis and abnormal ERCP had normal pancreatic function tests. ERCP increases the diagnostic yield in patients suspected of having pancreatitis and is at present the only reliable method of diagnosing pancreatic carcinoma which is not evident by other non-operative techniques. ERCP is also of value in the assessment of the severity of pancreatitis and is a necessary investigation before pancreatic surgery to confirm or exclude cyst formation or the site of duct obstruction. The finding of an unsuspected cyst at ERCP necessitates early operation because of the danger of introducing infection during the procedure.

Topics: Adolescent; Adult; Aged; Child; Cholangiography; Cholecystokinin; Chronic Disease; Endoscopy; Humans; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatic Diseases; Radiography; Secretin

In dogs provided with chronic gastric and pancreatic fistulas (Thomas cannula), an 80-minute intraduodenal CaCl2 (0.6 mM/kg.) infusion against a background of secretin perfusion (GIH, 1.0 CU/kg./hr.) elicits a complex "pancreon" response consisting of both excitatory and inhibitory effects on the protein and alkaline components, respectively, of pancreatic secretion. It is postulated that these pancreatic secretion changes are the result of the interplay of released CCK and calcitonin. The lack of pancreatic secretion modifications when ethanol (0.7 mg./kg.) was added to the intraduodenal CaCl2 infusion suggests that the former counteracts the effects of the latter on the nerves and/or the endocrine cells of the gut. Ca++ concentration and output in pancreatic secretion did not change significantly either with the intraduodenal CaCl2 alone or associated with ethanol. Fasting blood Ca++ levels were not modified either by the secretin perfusion or by the intraduodenal CaCl2 infusion, either given alone or associated with ethanol.

Topics: Alkalies; Animals; Calcitonin; Calcium; Calcium Chloride; Cholecystokinin; Chronic Disease; Dogs; Duodenum; Ethanol; Gastric Fistula; Infusions, Parenteral; Pancreas; Pancreatic Fistula; Pancreatic Juice; Proteins; Secretin

Topics: Cholecystokinin; Chronic Disease; Drug Evaluation; Duodenal Ulcer; Hepatitis; Humans; 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

After a review of the literature the author's results of testing pancreatic function in 445 patients with different diseases are reported. The activities of serum amylase and lipase were estimated before and after stimulation with secretin and pancreozymin; at the same time exocrine secretions of the pancreas were collected in the duodenum and analyzed. Serum enzyme activity did not change markedly after stimulation in pronounced pancreatic insufficiency. Measuring the enzyme activity thus helped to make the diagnosis only in a few cases with chronic pancreatitis and pancreatic carcinoma. In all other patients there was no correlation between changes of serum enzyme activities and changes of exocrine pancreatic function. Pathological test results, that means an increase in enzyme activity after stimulation, were found not only in patients with established or suspected pancreatic diseases, but also in many other subjects. Thus the diagnostic relevance of these tests seems to be rather limited, since it does not prove or exclude with sufficient specificity or adequate probability the presence of pancreatic diseases; it therefore cannot be recommended for screening purposes.

Topics: Amylases; Cholecystokinin; Chronic Disease; Diabetes Mellitus; Enzymes; Gastrointestinal Diseases; Humans; Kidney Failure, Chronic; Lipase; Liver Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Hepatitis; Humans; Liver Cirrhosis; Liver Cirrhosis, Biliary; Pancreas; Pancreatic Juice; Secretin

Topics: Cholecystokinin; Chronic Disease; Hepatitis; Humans; Liver Cirrhosis; Pancreas; Pancreatic Juice; Secretin; Secretory Rate

Topics: Cholangiography; Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatitis; Regression Analysis; Secretin

Topics: Adolescent; Adult; Bicarbonates; Cholecystokinin; Chronic Disease; Duodenal Ulcer; Female; Humans; Male; Middle Aged; Pancreas; Secretin

Investigating patients with chronic diseases of the liver, there will sometimes be found a symmetric hypertrophy of the parotid glands. Supposing, that enlargement of the parotid glands could equal an enhancement of parotid function, the authors investigated amylase and volume production of the parotid glands and at the same time that produced by pancreatic excretion during pancreozymin/secretin stimulation. They found a compensatory action of the parotidean function: In patients with only small liver cell damage they saw a diminished parotidean function together with an enhanced pancreatic excretion. In cases with severe liver cell alteration, the parotidean function was found to be greater than in normals, the pancreatic function diminished. The authors estimate the parotidean hypertrophy as a morphologic equivalent to the compensatory enhancement of parotidean function in cases with chronic liver diseases.

Topics: Amylases; Cholecystokinin; Chronic Disease; Duodenum; Intestinal Secretions; Liver Diseases; Pancreas; Parotid Gland; Saliva; Secretin

One hundred and thirty-nine patients were examined for possible chronic pancreatitis by means of both pancreozymin-secretin test and endoscopic pancreatography of pancreatocholangiography. Pancreatic function as assessed by the pancreozymin-secretin test was impaired in 89 (64%) of the entire group. No significant relationship was demonstrated between pancreatic secretion of fluid, bicarbonate and amylase and the diameter of main pancreatic duct in both the entire group of the subgroup of patients with pancreatic dysfunction. On pancreatogram no gross morphological abnormalities were found in a high proportion of patients whose pancreatic function was impaired in minimal to moderate degree. There was a significant linear correlation between the diameters of the main pancreatic duct and common bile duct. These data question the value of endoscopic pancreatography in the diagnosis of low to moderate grade chronic pancreatitis.

Topics: Adult; Aged; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Common Bile Duct; Duodenum; Humans; Intestinal Secretions; Middle Aged; Pancreatic Ducts; Pancreatitis; Radiography; Secretin

Topics: Cholecystokinin; Chronic Disease; Duodenum; Humans; Hydrogen-Ion Concentration; Injections, Intravenous; Methods; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin

Topics: Alanine Transaminase; Amylases; Animals; Atrophy; Bicarbonates; Blood Glucose; Cholecystokinin; Chronic Disease; Dogs; Fatty Acids, Unsaturated; Female; Glycerides; Intestinal Absorption; Linseed Oil; Male; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Secretory Rate; Stimulation, Chemical

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

A procedure was devised to quickly and reliably determine the patency of the cystic duct in patients suspected of having acute cholecystitis. First the gallbladder was stimulated to empty by a cholecystokinin injection. Thirty minutes later a radiolabeled biliary marker, either 150 muCi 131-I rose bengal or 2 mCi 99-mTc dihydrothioctic acid, was injected, and the accumulation of radioactivity in the liver and gallbladder regions was monitored by external gamma emission imaging and recording devices. The images of diagnostic importance were obtained between 60 and 90 minutes after injection of the tracer. Thirty-nine patients with acute abdominal pain were studied. Ten patients who had acute cholecystitis failed to show gallbladder accumulation of radioactivity, reflecting the cystic duct obstruction that initiates this disease. Twenty-nine patients having a variety of other diseases all showed gallbladder accumulation of activity, indicating in each patient that the cystic duct was patent. No significant adverse effects were noted. We conclude that the procedure is a useful adjunct to the clinical and roentgenographic evaluation of patients with acute abdominal pain.

Topics: Acute Disease; Adolescent; Adult; Aged; Cholecystitis; Cholecystokinin; Chronic Disease; Cystic Duct; Female; Gallbladder; Gallbladder Diseases; Humans; Male; Middle Aged; Pancreatitis; Radionuclide Imaging; Rose Bengal; Stimulation, Chemical; Technetium

Serum lipase activity was measured in 360 patients with the clinical suspicion of chronic pancreatic disease, 60 of them also having the lipase evocation test (serum lipase activity before and after pancreatic stimulation with secretin and pancreozymin). Of 48 with chronic pancreatitis (40 confirmed at operation) the diagnosis was made by endoscopic retrograde pancretography in all but one. Serum lipase activity was abnormal in 38. Without those cases associated with pancreatic insufficency, serum lipase activity-spontaneously and after the evocation test-was abnormal in 46 patients. Nine of 10 patients with papillary stenosis had the diagnosis confirmed at surgery, the pancretographic findings co-inciding with the surgical ones in all instances. All the five patients with abnormally high serum lipase activity also had chronic pancreatitis on pancreatography. In all of the 18 patients with pancreatic neoplasm pancreatography gave the same results as operation or post-mortem findings. In eight of these serum lipase activity was spontaneously elevated. The lipase evocation test was shown to be most effective if 2 C.H.R.- U/KG-h each of pancreozymin and secretin were administered. Serum lipase results were falsely positive in 17 of 300 patients with clinical suspicion of pancreatic disease but normal pancreatographic findings.

Topics: Adult; Aged; Alcoholism; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Duodenal Ulcer; Endoscopy; False Positive Reactions; Gallbladder Diseases; Hepatitis; Humans; Lipase; Liver Cirrhosis; Middle Aged; Pancreatic Neoplasms; Pancreatitis; Radiography; Secretin

Studies were undertaken in 40 patients with chronic pancreatitis six months to seven and a half years (mean 25 months) after operation, results being compared with pre-operative findings. Measurements included: exercise capacity, absence of pain, body weight, endocrine (36) and exocrine (25) pancreatic function. Almost all patients returned to full or only slightly impaired activity, were free of pain or had less pain and weight increase. Exocrine pancreatic function (secretin-pancreozymin test and faecal fat) was noted in 11 of 25 patients. In another 11 pre-operative progression was arrested. But endocrine function improved in only three of 36 and worsened in 13 (manifestation of subclinical diabetes in eight, worse glucose tolerance in five). The results justify a more active surgical approach in the treatment of chronic pancreatitis in order to save the patients from an often long and painful "burning out" of the disease on purely conservative treatment. Furthermore, exocrine pancreatic function, at least, is maintained or improved.

Topics: Adolescent; Adult; Body Weight; Cholecystokinin; Chronic Disease; Diabetes Complications; Feces; Female; Follow-Up Studies; Glucose Tolerance Test; Humans; Lipids; Male; Middle Aged; Pancreatitis; Secretin

Topics: Biological Assay; Cholecystokinin; Chronic Disease; Humans; Pancreatitis; Radioimmunoassay

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreatitis; Secretin

The effects of repeated injections of 75 U crude cholecystolinin-pancreozymin (CCK-PZ) at increasing plateau glucose concentrations achieved by glucose infusion were studied in 15 controls, 8 chronic pancreatitics and 8 mild maturity onset diabetics. In control subjects CCK-PZ alone caused minor insulin release but proportinally greater secretion with increasing blood glucose concentrations. Chronic pancreatitis patients who had normal responses to intravenous glucose responded normally to the CCK-PZ but at significantly higher plateau glucose levels. Diabetics had no response to IV glucose boluses of 5 g or 10 g, but with glucose infusions of 250-500 mg/min had almost normal insulin responses to CCK-PZ. The responses to CCK-PZ plus glucose were greater than either stimulus alone, indicating an interaction between these and the beta cell. These studies suggest that the gut homone-receptor in the beta cell is intact in maturity onset diabetes and chronic pancreatitis, whether the glucose receptor is normal or defective. The peptide-responsible in the crude CCK-PZ is not secretin, glucagon or gut glucagon, but may be gastric inhibitory polypeptide (GIP) since pure CCK-PZ has no insuli releasing properties.

Topics: Adult; Blood Glucose; Cholecystokinin; Chronic Disease; Diabetes Mellitus; Glucose; Humans; Insulin; Male; Middle Aged; Pancreatitis; Stimulation, Chemical

Topics: Cholangiography; Cholecystokinin; Chronic Disease; Endoscopy; Humans; Liver Diseases; Pancreas; Secretin

A specific substrate (Suphepa), which is well known in duodenal chymotrypsin determination (pancreozymin-secretin-test), is also suitable for the enzyme determination in stools from patients suspected of having a pancreas insufficiency of exocrine nature. The median value of 353 fecal chymotrypsin determination of 180 normal persons was 137 mug/g of native stool. There is a good correlation in comparing the fecal with the duodenal chymotrypsin: Out of 30 comparable patients, 10 patients had pathological values for the duodenal and fecal chymotrypsin determinations, whereas 18 patients had normal values. According to the results of the pancreozymin-secretin-test, false normal stool results were recorded for two patients. No false positive stool values were recorded for the comparative collective. The great accuracy, the modest instrumental expense and the negligible inconvenience for the patient are good in line with the requirements for a screening test.

Topics: Acute Disease; Anilides; Cholecystokinin; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Duodenum; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Feces; Humans; Indicators and Reagents; Intestinal Secretions; Pancreatic Diseases; Phenylalanine; Recurrence; Secretin

Abnormal pancreatic excretion of 5,5-dimethyl-2,4-oxazolidinedione (DMO) was demonstrated in 44 patients with chronic pancreatitis (14 with calcification and 30 without calcification). Pancreatic excretion of DMO in patients with chronic pancreatitis, as well as in normal subjects, depended on plasma DMO concentration and secretory volume. In the postsecretin 60-min period, almost all patients showed a decrease in total DMO output of duodenal aspirate over the observed range of plasma DMO concentration. More than half the patients without calcification gave a discordant pattern between the DMO output and volume, ie, decreased DMO output with normal volume secretion, while most of patients with calcification had low DMO output with decreased volume flow. The data of the pancreozymin-secretin test suggested that chornic pancreatic inflammation was moderate or minimal in patients without calcification and far advanced in those with calcification. From these results the hypothesis was advanced that DMO diffusion into the pancreatic ducts might be primarily impaired in the relatively early stage of chronic pancreatitis, and as the inflammation progressed to the final stage, DMO outflow from the ducts to the duodenum would be disturbed with evolving diffusion impairment of the compound. Total DMO output, when expressed as the output at a level of 10 mg/100 ml of plasma DMO (standard DMO output), was significantly reduced in chronic pancreatitis during a 60-min period after secretin stimulation. DMO in duodenal content, when expressed in terms of maximal concentration ratio of duodenal juice/plasma for the compound (maximal J/P ratio), was significantly low in chronic pancreatitis during the last 40-min period after secretin stimulation. These two parameters can therefore be used as indices of pancreatic excretion of DMO. The present technique may well become an effective diagnostic tool for early detection of chronic pancreatitis.

Topics: Adult; Cholecystokinin; Chronic Disease; Dimethadione; Duodenum; Female; Humans; Intestinal Secretions; Male; Middle Aged; Oxazoles; Pancreas; Pancreatitis; Secretin; Trimethadione

Topics: Acute Disease; Cholecystokinin; Chronic Disease; Computers; Humans; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin; Selenomethionine; Technetium

Topics: Adult; Aged; Amylases; Bicarbonates; Cholecystectomy; Cholecystitis; Cholecystokinin; Chronic Disease; Duodenal Ulcer; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Pancreas; Pancreatitis; Postoperative Complications; Secretin; Syndrome

Topics: Ceruletide; Cholecystokinin; Chronic Disease; Endoplasmic Reticulum; Golgi Apparatus; Humans; Insulin; Insulin Secretion; Microscopy, Electron; Pancreas; Pancreatic Diseases; Pancreatic Juice

Topics: Amylases; Animals; Cholecystokinin; Chronic Disease; Humans; Pancreatitis; Radioisotopes; Rats; Secretin; Selenium; Selenomethionine

Topics: Administration, Oral; Antigens; Arginine; Cholecystokinin; Chronic Disease; Glucagon; Glucose; Humans; Injections, Intravenous; Insulin; Insulin Secretion; Islets of Langerhans; Pancreatitis; Secretin; Time Factors; Tolbutamide

Topics: Acute Disease; Adult; Aged; Alcoholism; Biliary Tract Diseases; Blood Glucose; Cholecystokinin; Cholelithiasis; Chronic Disease; Diabetes Mellitus; Europe; Female; Glucagon; Humans; Insulin; Islets of Langerhans; Male; Middle Aged; Pancreatitis; Recurrence; Sex Factors; Stimulation, Chemical; United States

Topics: Bicarbonates; Cholecystokinin; Chronic Disease; Humans; Hydrogen-Ion Concentration; Pancreas; Pancreatic Juice; Pancreatitis; Peptide Hydrolases; Secretin; Stimulation, Chemical; Time Factors

Topics: Acetylcholine; Acute Disease; Alcoholism; Antigen-Antibody Reactions; Cholecystokinin; Chronic Disease; Cortisone; Drug Interactions; Female; Humans; Hyperparathyroidism; Male; Nutrition Disorders; Pancreas; Pancreatitis; Radionuclide Imaging

Topics: Adolescent; Adult; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Cobalt Radioisotopes; Diabetes Mellitus, Type 1; Female; Humans; Injections, Intravenous; Lipase; Male; Pancreatic Diseases; Pancreatitis; Proteins; Secretin; Trypsin; Vitamin B 12

Topics: Adult; Amylases; Cholecystokinin; Cholelithiasis; Chronic Disease; Diagnosis, Differential; Duodenal Diseases; Endoscopy; Female; Glucose Tolerance Test; Humans; Liver Diseases; Male; Middle Aged; Pancreas; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatitis; Radiography; Secretin

Topics: Adult; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Cobalt Radioisotopes; Depression, Chemical; Duodenum; Female; Gastric Juice; Humans; Male; Pancreas; Pancreatitis; Secretin; Stimulation, Chemical; Time Factors; Trypsin; Vitamin B 12

Topics: Adolescent; Adult; Aged; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Bile Acids and Salts; Cholecystokinin; Cholesterol; Chronic Disease; Duodenum; Fasting; Female; Follow-Up Studies; Hepatitis; Humans; Hydroxysteroid Dehydrogenases; Injections, Intravenous; Liver Cirrhosis; Male; Middle Aged; Taurocholic Acid

Topics: Adolescent; Adult; Aged; Bilirubin; Cholecystitis; Cholecystokinin; Chronic Disease; Duodenum; Female; Humans; Intestinal Secretions; Male; Middle Aged; Stimulation, Chemical

Topics: Acute Disease; Adolescent; Adult; Aged; Amino Acids; Cholecystokinin; Chronic Disease; Duodenum; Fats; Feces; Female; Humans; Infusions, Parenteral; Lipase; Male; Middle Aged; Nitrogen; Pancreas; Pancreatitis; Perfusion; Steatorrhea; Stimulation, Chemical; Trypsin

Topics: Acute Disease; Adult; Aged; Amylases; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Female; Humans; Lipase; Male; Middle Aged; Morphine; Neostigmine; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin; Stimulation, Chemical; Time Factors; Trypsin

The uptake of (75)Se Selenomethionine by the pancreas has been evaluated in 102 patients and compared with the secretin-pancreozymin test of pancreatic function. In groups of patients with chronic pancreatitis and cancer of the pancreas abnormal scans closely parallel the diminished exocrine secretion, especially bicarbonate output, following a submaximal dose of secretin. Thirty per cent of the group with no pancreatic abnormality have abnormal scans, though the secretinpancreozymin test is normal. Though a normal scan excludes the presence of chronic pancreatitis and cancer of the pancreas with a probability greater than 90%, an abnormal scan is found so frequently in normal subjects that it does not provide a reliable index of impaired pancreatic function.

Topics: Bicarbonates; Celiac Disease; Cholecystokinin; Chronic Disease; Humans; Jaundice; Liver Cirrhosis; Liver Cirrhosis, Biliary; Methionine; Pancreas; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin; Selenium

Topics: Adolescent; Adult; Aged; Carcinoma; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Diagnosis, Differential; Female; Humans; Male; Methods; Middle Aged; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Sarcoma; Secretin

Topics: Amylases; Cholecystokinin; Chronic Disease; Chymotrypsin; Female; Humans; Lipase; Male; Pancreas; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin; Stimulation, Chemical; Trypsin

Topics: Amylases; Bicarbonates; Bile Acids and Salts; Bilirubin; Carcinoma; Cholecystokinin; Chronic Disease; Duodenum; Humans; Infusions, Parenteral; Injections, Intravenous; Intestinal Secretions; Lipase; Pancreas; Pancreatic Neoplasms; Pancreatitis; Secretin; Secretory Rate; Stimulation, Chemical; Trypsin

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: Acute Disease; Cholecystitis; Cholecystokinin; Chronic Disease; Gallbladder; Humans; Pancreas; Pancreatic Elastase; Pancreatitis; Phospholipases; Secretin; Trypsin

Topics: Amylases; Cholecystokinin; Chronic Disease; Female; Humans; Male; Pancreatic Juice; Pancreatitis; Secretin

Topics: Bile Acids and Salts; Cholecystokinin; Chronic Disease; Circadian Rhythm; Duodenum; Fasting; Female; Gallbladder; Hepatitis; Humans; Liver Cirrhosis; Liver Diseases; Male; Taurocholic Acid

Topics: Amylases; Cholecystokinin; Chronic Disease; Chymotrypsin; Clinical Enzyme Tests; Feces; Humans; Lipase; Pancreatic Diseases; Pancreatic Juice; Secretin; Secretory Rate; Stimulation, Chemical; Trypsin

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: Amylases; Cholecystokinin; Chronic Disease; Hepatitis; Hepatitis A; Humans; Pancreas; Pancreatic Ducts; Secretin; Trypsin

Topics: Adult; Cholecystokinin; Chronic Disease; Female; Humans; Male; Pancreas; Pancreatitis; Radionuclide Imaging; Secretin

Topics: Amylases; Autopsy; Cholecystokinin; Chronic Disease; Endoscopy; Female; Fiber Optic Technology; Humans; Pancreas; Pancreatic Ducts; Pancreatitis; Radiography; Secretin

Topics: Acute Disease; Adult; Ampulla of Vater; Cholecystectomy; Cholecystokinin; Chronic Disease; Female; Gastroenterostomy; Humans; Jaundice; Male; Methods; Pancreatitis

Topics: Adolescent; Bile Acids and Salts; Bile Ducts; Bile Ducts, Intrahepatic; Body Weight; Celiac Disease; Child; Child, Preschool; Cholecystokinin; Cholestyramine Resin; Chronic Disease; Diet Therapy; Dietary Fats; Duodenum; Female; Humans; Infant; Intestinal Secretions; Liver Cirrhosis; Liver Diseases; Liver Function Tests; Male; Triglycerides

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: Ascites; Biopsy; Cholecystokinin; Chronic Disease; Diagnosis, Differential; Duodenum; Emaciation; Endoscopy; Humans; Pain; Pancreas; Pancreatectomy; Pancreatic Cyst; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Acute Disease; Adult; Aged; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Female; Food; Humans; Male; Methods; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin

Topics: Alcoholism; Animals; Chemical Precipitation; Cholecystokinin; Chronic Disease; Humans; Pancreatic Ducts; Pancreatic Juice; Pancreatitis; Rats

Topics: Amylases; Bile; Biliary Tract Diseases; Cholecystokinin; Chronic Disease; Duodenal Diseases; Duodenum; Enzymes; Gallbladder Diseases; Gastrointestinal Diseases; Humans; Intestinal Secretions; Lipase; Liver Diseases; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Acute Disease; Bicarbonates; Calcium; Cholecystokinin; Chronic Disease; Duodenum; Enzymes; Factor Analysis, Statistical; Gastrointestinal Diseases; Humans; Intestinal Secretions; Pancreas; Pancreatitis; Secretin; Statistics as Topic

Topics: Acute Disease; Amylases; Cholecystokinin; Chronic Disease; Enzymes; Humans; Intestinal Absorption; Malabsorption Syndromes; Pancreas; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Secretin; Secretory Rate

Topics: Amylases; Angiography; Bicarbonates; Cholecystokinin; Chronic Disease; Chymotrypsin; Duodenum; Germany, West; Humans; Intestinal Secretions; Lipase; Pancreatitis; Secretin; Trypsin

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: Cholecystokinin; Chronic Disease; Humans; Hydrochloric Acid; Liver Cirrhosis; Pancreas; Pancreatic Diseases; Pancreatitis; Secretin

Topics: Adolescent; Adult; Age Factors; Celiac Disease; Child; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Diabetes Mellitus; Feces; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain; Pancreas; Pancreatitis; Time Factors

Topics: Adult; Aged; Cholecystokinin; Chronic Disease; Duodenal Ulcer; Duodenum; Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastrins; Histamine; Humans; Injections, Intravenous; Male; Middle Aged; Pancreatitis; Secretin; Secretory Rate; Stomach

Topics: Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Humans; Injections, Intravenous; Kidney Diseases; Kidney Failure, Chronic; Lipase; Methods; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin

Topics: Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Duodenum; Gallbladder Diseases; Gastrointestinal Diseases; Humans; Intestinal Secretions; Leucyl Aminopeptidase; Liver Cirrhosis; Pancreatic Juice; Pancreatitis; Secretin; Zinc

Topics: Adult; Aged; Calcium; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Duodenum; Female; Humans; Intestinal Secretions; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Potassium; Secretin; Sodium

Topics: Acute Disease; Amylases; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Humans; Lipase; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Recurrence; Secretin

Topics: Cholecystokinin; Chronic Disease; Duodenum; Humans; Intestinal Secretions; Methacholine Compounds; Pancreatic Juice; Pancreatitis; Peptide Hydrolases; Proteins; Secretin; Stimulation, Chemical

Topics: Afferent Loop Syndrome; Cholecystokinin; Chronic Disease; Gastrectomy; Gastrins; Humans; Methods; Recurrence; Secretin; Stomach Ulcer

Topics: Acute Disease; Cholecystokinin; Chronic Disease; Humans; Neostigmine; Pancreatic Neoplasms; Pancreatitis

Topics: Angiography; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Glucose Tolerance Test; Humans; Iodine Radioisotopes; Lipids; Methods; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin

Topics: Cholecystokinin; Chronic Disease; Humans; Methods; Pancreatitis; Retrospective Studies; Secretin

Topics: Cholecystokinin; Chronic Disease; Humans; Lipase; Pancreatitis; Secretin

Topics: Amylases; Bicarbonates; Bilirubin; Cholecystokinin; Chronic Disease; Duodenum; Gastrins; Humans; Lipase; Methods; Pancreatic Juice; Pancreatitis; Peptides; Secretin; Stimulation, Chemical; Stomach; Trypsin

Topics: Adult; Aged; Alcoholism; Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Feces; Female; Gastric Acidity Determination; Gastric Juice; Gastric Mucosa; Gastritis; Humans; Lipids; Male; Middle Aged; Pancreas; Pancreatic Juice; Pancreatitis; Secretin

Topics: Adult; Amylases; Bicarbonates; Carboxypeptidases; Cholecystokinin; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Diet Therapy; Female; Humans; Injections, Intravenous; Lipase; Male; Middle Aged; Pancreas; Pancreatitis; Secretin; Secretory Rate; Trypsin

Topics: Acute Disease; Calcium; Celiac Disease; Cholecystography; Cholecystokinin; Chronic Disease; Clinical Enzyme Tests; Exocrine Glands; Glucose Tolerance Test; Humans; Hypocalcemia; Hypoparathyroidism; Male; Middle Aged; Pancreatitis; Radionuclide Imaging; Secretin; Triglycerides

Topics: Adult; Aged; Amylases; Bicarbonates; Celiac Disease; Cholecystokinin; Chronic Disease; Duodenum; Fats; Feces; Female; Humans; Intestinal Secretions; Male; Middle Aged; Pancreatic Juice; Pancreatitis; Secretin

Topics: Cholecystokinin; Chronic Disease; Duodenal Diseases; Electrophoresis; Gallbladder; Humans; Stimulation, Chemical

Topics: Cholecystokinin; Chronic Disease; Humans; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Amylases; Cholecystokinin; Chronic Disease; Humans; Pancreatic Diseases; Pancreatitis

Topics: Aged; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin

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