cholecystokinin and Malabsorption-Syndromes

Normal digestive physiology is a highly orchestrated process, integrating the mechanical breakdown of food, the secretion of digestive juices, the control of motility, and the efficient absorption of nutrients. As enteral and parenteral feeding techniques bypass many of these control mechanisms, nutritional utilization can be expected to be disturbed. This review examines recent publications that have investigated this question in clinical practice.. Studies in healthy volunteers have shown that all forms of oral and enteral tube feeds commonly used, including proximal jejunal elemental diets, stimulate pancreatic secretion. Avoidance of the cephalic phase with duodenal feeding does not reduce the secretory response. 'Pancreatic rest' can, however, be achieved if feeding is delivered 40-60 cm past the ligament of Treitz by activating the ileal brake, or if it is given intravenously by avoiding intestinal cholecystokinin stimulation and the cholinergic reflex. These forms of feeding, however, can cause complications as they will result in malabsorption unless elemental formulae are used, and hyperglycemia as the metabolic utilization of intravenous nutrients is impaired.. An understanding of normal pancreatic physiology and how interventional feeding techniques affect it will help prevent complications and improve outcome in hospitalized patients.

Topics: Cholecystokinin; Enteral Nutrition; Hospitalization; Humans; Hyperglycemia; Malabsorption Syndromes; Pancreas; Parenteral Nutrition

Chronic pancreatitis represents a condition that is challenging for clinicians secondary to the difficulty in making an accurate diagnosis and the less than satisfactory means of managing chronic pain. This review emphasises the various manifestations that patients with chronic pancreatitis may have and describes recent advances in medical and surgical therapy. It is probable that many patients with chronic abdominal pain are suffering from chronic pancreatitis that is not appreciated. As the pathophysiology of this disorder is better understood it is probable that the treatment will be more successful.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Clinical Enzyme Tests; Diagnosis, Differential; Endoscopy, Digestive System; Female; Humans; Islets of Langerhans Transplantation; Malabsorption Syndromes; Male; Nerve Block; Oxidative Stress; Pain; Pain Management; Pancreas; Pancreatitis, Chronic

Topics: Adaptation, Physiological; Animals; Blood Glucose; Cholecystokinin; Dietary Carbohydrates; Dietary Fiber; Digestion; Humans; Intestinal Absorption; Intestine, Small; Malabsorption Syndromes; Microvilli; Monosaccharides; Oligosaccharides; Pancreas; Risk; Starch; Structure-Activity Relationship

Topics: 4-Aminobenzoic Acid; Amino Acids; Amylases; Ceruletide; Cholecystokinin; Creatine; Feces; Humans; Isoenzymes; Lipase; Lipids; Malabsorption Syndromes; Nitrogen; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Pancreatic Juice; Radionuclide Imaging; Secretin

Topics: Bile; Binding Sites; Celiac Disease; Cholecystokinin; Cholestyramine Resin; Diarrhea; Diet Therapy; Digestion; Fatty Acids, Nonesterified; Humans; Hydrolysis; Malabsorption Syndromes; Neomycin; Phospholipids; Secretin; Triglycerides

Direct measurement of pancreatic enzymes is the gold standard in the evaluation of exocrine pancreatic function. The purpose of our study was to evaluate the use of cholecystokinin as a single-agent secretagogue for pancreatic drainage studies. Twenty pediatric patients received cholecystokinin (group 1) and 40 patients received either secretin plus placebo (group 2) or secretin plus cholecystokinin (group 3). Duodenal fluid was collected for measurement of lipase, amylase, trypsin, chymotrypsin. The mean lipase and amylase activities were higher in group 3 and the mean trypsin and chymotrypsin activities were higher in group 1, but none of these observations were statistically significant. Group 3 had more patients with all four enzymes being normal (75%) compared to groups 1 (60%) and 2 (50%) (P = 0.262). Patients in all three groups had at least one normal enzyme. Cholecystokinin is useful as a single agent for direct pancreatic enzyme measurements in the absence of commercially available secretin.

Topics: Adolescent; Amylases; Child; Child, Preschool; Cholecystokinin; Chymotrypsin; Diagnosis, Differential; Drug Synergism; Failure to Thrive; Female; Humans; Infant; Lipase; Malabsorption Syndromes; Male; Pancreatic Function Tests; Pancreatic Juice; Pilot Projects; Prospective Studies; Secretin; Trypsin

Enteroendocrine cells secrete over a dozen different hormones responsible for coordinating digestion, absorption, metabolism, and gut motility. Loss of enteroendocrine cells is a known cause of severe congenital diarrhea. Furthermore, enteroendocrine cells regulate glucose metabolism, with the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) playing critical roles in stimulating insulin release by pancreatic β-cells. Islet1 (Isl1) is a LIM-homeodomain transcription factor expressed specifically in an array of intestinal endocrine cells, including incretin-expressing cells. To examine the impact of intestinal Isl1 on glycemic control, we set out to explore the role of intestinal Isl1 in hormone cell specification and organismal physiology. Mice with intestinal epithelial-specific ablation of Isl1 were obtained by crossing Villin-Cre transgenic animals with mice harboring a Isl1(loxP) allele (Isl1(int) model). Gene ablation of Isl1 in the intestine results in loss of GLP-1, GIP, cholecystokinin (CCK), and somatostatin-expressing cells and an increase in 5-HT (serotonin)-producing cells, while the chromogranin A population was unchanged. This dramatic change in hormonal milieu results in animals with lipid malabsorption and females smaller than their littermate controls. Interestingly, when challenged with oral, not intraperitoneal glucose, the Isl-1 intestinal-deficient animals (Isl1(int)) display impaired glucose tolerance, indicating loss of the incretin effect. Thus the Isl1(int) model confirms that intestinal biology is essential for organism physiology in glycemic control and susceptibility to diabetes.

Topics: Age Factors; Animals; Animals, Newborn; Biomarkers; Blood Glucose; Cholecystokinin; Chromogranin A; Diarrhea; Dietary Fats; Enteroendocrine Cells; Female; Gastric Inhibitory Polypeptide; Gastrins; Genotype; Ghrelin; Glucagon-Like Peptide 1; Glucose Metabolism Disorders; Glucose Tolerance Test; Integrases; Intestinal Absorption; Intestinal Mucosa; Intestine, Small; LIM-Homeodomain Proteins; Malabsorption Syndromes; Male; Mice, Inbred C57BL; Mice, Knockout; Microfilament Proteins; Phenotype; Serotonin; Somatostatin; Transcription Factors; Weight Gain

Topics: Biopsy; Cholecystokinin; Duodenum; Enteroendocrine Cells; Gastric Inhibitory Polypeptide; Humans; Malabsorption Syndromes; Male; Middle Aged; Peptide YY; Polyendocrinopathies, Autoimmune

Topics: Cholecystokinin; Humans; Malabsorption Syndromes; Polyendocrinopathies, Autoimmune

Topics: Autoantibodies; Cholecystokinin; Duodenum; Enterochromaffin Cells; Humans; Malabsorption Syndromes; Polyendocrinopathies, Autoimmune; Serotonin; Tryptophan Hydroxylase

Subsequent to total gastrectomy, many patients develop maldigestion and weight loss. The mechanisms that underlie these changes are not known. Therefore, in a prospective study, we have analyzed endocrine and exocrine pancreatic function in patients before and 3 months after total gastrectomy.. In 15 patients (12 male, three female, median age 62.4 yr) undergoing total gastrectomy due to gastric cancer, a direct exocrine pancreatic function test (secretin-cerulein test) was performed. In addition, a standard test meal was given to all patients to study endocrine pancreatic function and the pattern of hormones that influence exocrine pancreatic secretion. In nine patients, both function tests were repeated 3 months after total gastrectomy. Before and at 11 points after the application of the test meal, blood samples were taken for the measurement of glucose, insulin, glucagon, gastrin, pancreatic polypeptide, and cholecystokinin. In addition, a secretin-cerulein test was performed to analyze trypsin, chymotrypsin, amylase, bicarbonate, and the juice volume in the duodenal aspirates.. Three months after total gastrectomy, all patients exhibited severe primary exocrine pancreatic insufficiency. Secretin-cerulein tests revealed that pancreatic juice secretion, trypsin, chymotrypsin, and amylase were significantly reduced by 76%, 89%, 91%, and 72%, respectively, 3 months after total gastrectomy and secretin and cerulein stimulation. Post-operatively, the patients had a pathological glucose tolerance with increased postprandial insulin and glucagon secretion. The baseline and postprandial gastrin and pancreatic polypeptide secretion were significantly decreased after total gastrectomy. In contrast, early postprandial cholecystokinin secretion was significantly increased postoperatively.. After total gastrectomy, patients develop severe primary exocrine pancreatic insufficiency with decreased gastrin, decreased late postprandial pancreatic polypeptide, and increased cholecystokinin levels. These findings may explain why many patients with total gastrectomy have maldigestion and weight loss postoperatively. Therefore, gastrectomized patients should be given pancreatic enzymes to avoid these symptoms.

Topics: Ceruletide; Cholecystokinin; Exocrine Pancreatic Insufficiency; Female; Glucagon; Glucose Tolerance Test; Humans; Insulin; Insulin Secretion; Malabsorption Syndromes; Male; Middle Aged; Pancreatic Function Tests; Pancreatic Polypeptide; Postgastrectomy Syndromes; Prospective Studies; Secretin; Time Factors; Weight Loss

Topics: Adult; Cholecystokinin; Gastrectomy; Gastrointestinal Agents; Humans; Malabsorption Syndromes; Male; Postgastrectomy Syndromes

Fat absorption was studied in 10 patients recovering from an episode of acute infectious gastroenteritis who failed to gain weight despite adequate caloric intake. Three patients restudied after clinical improvement and three other infants with failure to thrive, unrelated to gastrointestinal problems, served as control subjects. Fat balance studies during the ingestion of a formula containing long-chain fatty acids demonstrated significant degrees of steatorrhea in patients (mean CFA 70.6 +/- 10.7 compared to 90.3 +/- 2.4 in control subjects). The administration of a test meal demonstrated a marked deficiency of duodenal bile acid concentration and of fat incorporation into the micellar phase in patients. Fecal bile acid excretion was significantly increased in patients (mean 33.9 +/- 11.6 microM/kg/day) as compared to control subjects (mean 13.5 +/- 3.1 microM/kg/day). Bacterial overgrowth and abnormalities of the small intestinal mucosa were not constant. Ileal dysfunction and associated bile acid loss are possible causes of disturbed fat assimilation following acute intestinal infection in children.

Topics: Acute Disease; Bile Acids and Salts; Body Fluids; Cholecystokinin; Diarrhea, Infantile; Dietary Fats; Duodenum; Escherichia coli Infections; Feces; Gastroenteritis; Humans; Infant; Intestinal Absorption; Lipid Metabolism; Lipids; Malabsorption Syndromes; Micelles; Salmonella Infections; Salmonella typhimurium

Extensive metabolic studies were conducted in five normal controls and in five study patients after total gastric resection with Roux-en-Y (RY) reconstruction to determine the nutritional consequences of this particular technique of restoring gastrointestinal continuity. Although malabsorption of fat (19.2 +/- 2.2%) and nitrogen (22 +/- 2.5%) demonstrated in the study patients was moderate, it was significantly greater than normal ( less than 0.01). In spite of the demonstrated malabsorption, however, positive nitrogen balances (+ 0.33 +/- 0.18 gm/day) were maintained in the RY patients throughout the investigative period. These observations suggest that malabsorption after RY is infrequently of clinical significance, even in this "worst-case" situation characterized by complete removal of gastric tissue. Malnutrition should occur in only those patients with more limited gastric resections and RY reconstruction who are unable to increase caloric intake to cover losses due to malabsorption. A significant decrease in both trypsin and lipase concentrations and a marked delay in secretion of these enzymes was noted in the RY patients in response to a test meal (p less than 0.01). Malabsorption of fat and nitrogen in RY patients improved after exogenous pancreatic enzymes, but not after administration of tetracycline. Bacterial overgrowth as a cause of postoperative malabsorption may be less important than previously thought. Malabsorption after RY is due primarily to maldigestion brought about by duodenal bypass which, in turn, results in either an absolute or a relative pancreatic enzyme insufficiency.

Topics: Bile Acids and Salts; Cholecystokinin; Dietary Fats; Female; Gastrectomy; Gastrins; Humans; Jejunum; Lipase; Malabsorption Syndromes; Male; Nitrogen; Postgastrectomy Syndromes; Secretin; Tetracycline; Trypsin

Idiopathic late-onset immunoglobulin deficiency in a young man was associated with achlorhydria and a severe intestinal malabsorption syndrome that did not respond to conventional therapy. Combined therapy with high doses of prednisone and tetracycline hydrochloride resulted in weight gain, cessation of diarrhea, improved absorption of water, fat, and vitamin B12, and production of gastric acid after stimulation with histamine. Serum immunoglobulin levels, however, did not increase.

Topics: Achlorhydria; Adult; Age Factors; Body Weight; Celiac Disease; Cholecystokinin; Diarrhea; Drug Therapy, Combination; Humans; Immunoglobulin M; Immunologic Deficiency Syndromes; Malabsorption Syndromes; Male; Prednisone; Tetracycline; Vitamin B 12

The vitamin A absorption test and its interaction with the secretin-pancreozymin test, the d-xylose absorption test, fecal fat content and the small intestine biopsy are estimated on their significance in the diagnosis and course of sprue and pancreatic insufficiency. The investigation includes 39 patients with different stages of pancreatic insufficiency and 10 patients with sprue. First it results relatively wide spread normal values in a control collective with sometimes unexplained low values, the significance of the vitamin A absorption test as screening test therefore is limited. Secondly the absent rise after vitamin A ingestion in serum after 3 and 6 hours favours the diagnosis of sprue, correlates with the histological findings of the mucosa and appears more reliable than the d-xylose test. Thirdly this test seems to allow the differentiation between malabsorption and maldigestion when steathorroe is proved: In contrast to sprue-syndromes pancreatic insufficiency shows significant reduced 3 hour values at subnormal 6 hour values after vitamin A ingestion.

Topics: Adult; Celiac Disease; Cholecystokinin; Diagnosis, Differential; Feces; Humans; Lipids; Malabsorption Syndromes; Pancreatic Diseases; Secretin; Time Factors; Vitamin A; Xylose

Topics: Aged; Alcoholism; Biopsy, Needle; Cholecystokinin; Chymotrypsin; Drainage; Duodenum; Eating; Fatty Liver; Feces; Female; Humans; Lipid Metabolism; Lipids; Liver; Liver Cirrhosis; Malabsorption Syndromes; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin

Topics: Aged; Alcoholism; Bicarbonates; Cholecystokinin; Chymotrypsin; Female; Humans; Liver Cirrhosis; Malabsorption Syndromes; Male; Middle Aged; Pancreas; Secretin

Topics: Bile Acids and Salts; Child; Child, Preschool; Cholecystokinin; Diarrhea; Humans; Infant; Injections, Intravenous; Intestine, Small; Intubation, Gastrointestinal; Malabsorption Syndromes; Methods; Pancreas

Topics: Amylases; Bicarbonates; Celiac Disease; Cholecystokinin; Diet; Folic Acid Deficiency; Humans; Intestinal Diseases; Intestine, Small; Malabsorption Syndromes; Nutrition Disorders; Pancreas; Protein Deficiency; Secretin; Serum Albumin

Topics: Aged; Bile Acids and Salts; Blind Loop Syndrome; Carbon Isotopes; Chlortetracycline; Cholecystokinin; Cholesterol; Chromatography, Thin Layer; Diverticulum; Female; Glycine; Humans; Injections, Intravenous; Jejunum; Malabsorption Syndromes; Methods; Taurine

Topics: Adult; Angiography; Celiac Artery; Cholecystokinin; Collateral Circulation; Female; Gastric Juice; Humans; Intestinal Absorption; Malabsorption Syndromes; Male; Mesenteric Arteries; Mesenteric Vascular Occlusion; Middle Aged; Secretin; Stimulation, Chemical

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: Bicarbonates; Bilirubin; Cholecystokinin; Gallbladder; Humans; Injections, Intravenous; Intubation, Gastrointestinal; Lipase; Malabsorption Syndromes; Pancreas; Stimulation, Chemical

Topics: Carnitine; Cholecystokinin; Digestion; Dogs; Enzymes; Gastrointestinal Hormones; Guinea Pigs; Malabsorption Syndromes; Metabolism; Pancreatic Juice; Pancreatitis; Pancreatitis, Chronic; Pathology; Pharmacology; Research; Secretin; Vitamin B Complex