cholecystokinin and Pancreatic-Diseases

A brief report is given on the possible role of oxygen-derived free radicals and cholecystokinin in the pathogenesis of experimentally induced acute pancreatitis. Furthermore, use of scavengers (superoxide dismutase, catalase), CCK-receptor antagonists and somatostatin are discussed in the therapy of acute pancreatitis induced in animal models. It is suggested that both the term of direct pancreatic cytoprotection of the above-mentioned agents and the validity of the animal models used for induction of acute pancreatitis have to be reconsidered.

Topics: Animals; Cholecystokinin; Free Radicals; Humans; Pancreatic Diseases; Pancreatitis

Cholecystokinin (CCK) is one of the most important regulators of pancreatic and digestive physiology. Its importance led to research and discovery of a number of CCK receptor antagonists. Some of them are experimentally and clinically used today in order to assess the relative contribution of CCK to different aspects of pancreatic physiology. Furthermore, clinical trials are running with the aim of determining their possible therapeutic indications in pancreatic diseases, such as acute and chronic pancreatitis or pancreatic carcinoma. The rationale and evidence for their use are discussed.

Topics: Animals; Cholecystokinin; Humans; Pancreas; Pancreatic Diseases

Topics: Animals; Cattle; Cholecystokinin; Dogs; Enteral Nutrition; Epidermal Growth Factor; Gastrins; Hormones; Humans; Insulin; Intestine, Small; Pancreas; Pancreatic Diseases; Pancreatic Polypeptide; Parasympathomimetics; Pituitary Gland; Rats; Secretin; Trypsin Inhibitors

Regulation of pancreatic exocrine secretion is comprised of a complex interplay between hormonal and nervous mechanisms. Stimulatory gut hormones which act via the circulation include secretin, CCK, gastrin and bombesin, while VIP operates through peptidergic nervous release. Pancreatic polypeptide and glucagon are two examples of circulating inhibitory hormones while inhibition by somatostatin is through a paracrine release mechanism. Although the effects of vagal cholinergic nerves have been previously thought to be indirect through hormone release evidence is now accumulating for a direct role. Altered hormone release has been noted in chronic pancreatic insufficiency, cystic fibrosis and coeliac disease and may contribute in an important way to the pathophysiology of these malabsorptive disorders.

Topics: Autonomic Nervous System; Bombesin; Cholecystokinin; Enkephalins; Gastrins; Gastrointestinal Hormones; Humans; Neurotensin; Pancreas; Pancreatic Diseases; Pancreatic Polypeptide; Secretin; Somatostatin; Vagus Nerve; Vasoactive Intestinal Peptide

Topics: Animals; Bombesin; Cholecystokinin; Endorphins; Gastrins; Hormones; Humans; Islets of Langerhans; Nerve Tissue Proteins; Neurons; Neurotensin; Pancreatic Diseases; Reflex; Somatostatin; Vasoactive Intestinal Peptide

Topics: 4-Aminobenzoic Acid; Animals; Cholecystokinin; Clinical Enzyme Tests; Diagnosis, Differential; Duodenum; Feces; Humans; Intestinal Secretions; Pancreatic Diseases; Pancreatic Function Tests; Pancreatic Juice; para-Aminobenzoates; Secretin

Topics: Amino Acid Metabolism, Inborn Errors; Amylases; Child, Preschool; Cholecystokinin; Cystic Fibrosis; Dicloxacillin; Humans; Infant; Infant, Newborn; Kidney Diseases; Lipase; Lipid Metabolism, Inborn Errors; Pancreas; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Extracts; Prognosis; Secretin; Triglycerides; Trypsinogen; Uric Acid

Topics: Cholecystokinin; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Diseases; Gastrointestinal Hormones; Humans; Pancreatic Diseases; Secretin; Vasoactive Intestinal Peptide

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: 4-Aminobenzoic Acid; Amino Acids, Essential; Bicarbonates; Body Fluids; Cholecystokinin; Chymotrypsin; Duodenum; Feces; Humans; Meat; Pancreas; Pancreatic Diseases; para-Aminobenzoates; Perfusion; Radiography; Radioisotopes; Secretin; Staining and Labeling; Trypsin; Tyrosine

Topics: Animals; Cholecystokinin; Dogs; Gastric Inhibitory Polypeptide; Gastric Juice; Gastrins; Gastrointestinal Hormones; Humans; Pancreatic Diseases; Radioimmunoassay; Secretin; Syndrome; Vasoactive Intestinal Peptide; Zollinger-Ellison Syndrome

Topics: Amylases; Cholecystokinin; Humans; Pancreas; Pancreatic Diseases; Pancreatic Hormones; Pancreatic Juice; Secretin; Secretory Rate; Selenomethionine

Topics: Biopsy; Carcinoembryonic Antigen; Celiac Artery; Cholangiography; Cholecystokinin; Lactoferrin; Laparoscopy; Mesenteric Arteries; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin; Tomography, X-Ray Computed; Ultrasonography

Topics: Amylases; Bicarbonates; Biliary Tract Diseases; Carbohydrate Metabolism; Child; Cholecystokinin; Chymotrypsin; Duodenum; Feces; Humans; Lipase; Methods; Pancreas; Pancreatic Diseases; Pancreatic Hormones; Pancreatic Neoplasms; Pancreatitis; Radiography; Secretin; Trypsin

Topics: Animals; Bicarbonates; Chemoreceptor Cells; Cholecystokinin; Digestion; Food; Gastrins; Humans; Intestinal Mucosa; Pancreas; Pancreatic Diseases; Pancreatic Hormones; Pancreatic Juice; Secretin; Sensory Receptor Cells

Topics: Adolescent; Adult; Aminobenzoates; Amylases; Animals; Bicarbonates; Catalase; Cholecystokinin; Chymotrypsin; Clinical Enzyme Tests; Female; Haplorhini; Humans; Intestinal Mucosa; Lipase; Lipid Metabolism; Male; Middle Aged; Pancreas; Pancreatic Diseases; Protein-Energy Malnutrition; Proteins; Secretin; Starch; Trypsin

Tumoral secretions and pathophysiology of diarrhea were studied in 1 patient with pancreatic cholera. High concentrations of vasoactive intestinal peptide were found in both systemic blood and tumoral extracts, together with increased plasma levels of calcitonin and protaglandins E and Falpha. Gastric inhibitory peptide and gastrointestinal and pancreatic hormones were absent from the tumor, except for small amounts of glucagon, and their blood levels were normal. Decreased basal but normal pentagastrin-stimulated gastric acid secretion, normal basal and secretin-stimulated pancreatic secretion, increased volume of gallbladder bile with high bicarbonate, and low bile salt concentrations were observed, but the electrolyte content and flow rate of fluid passing the duodenojejunal junction were within normal limits. Small intestine was found to be the origin of the water and electrolyte fasting losses. Jejunum was the site of bicarbonate secretion. Jejunal glucose and leucine-stimulated water and sodium transports were also strikingly decreased, whereas the absorption rates of the sugar and amino acid were normal. Colon reabsorbed high amounts of water and sodium but increased potassium losses. Biological effects of vasoactive intestinal peptide may explain most of the patient's upper digestive secretion abnormalities and small intestinal function impairments, whereas secondary aldosteronism might explain the modified colonic function.

Topics: Adult; Bile; Blood Vessels; Calcitonin; Cholecystokinin; Cholera; Colon; Depression, Chemical; Diarrhea; Duodenum; Feces; Female; Gastric Mucosa; Gastrins; Glucagon; Humans; Ileostomy; Insulin; Insulin Secretion; Intestinal Secretions; Intestine, Small; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Peptides; Prostaglandins E; Prostaglandins F; Secretin; Stomach

Topics: Amylases; Breath Tests; Carbon Dioxide; Cholecystokinin; Chymotrypsin; Diet; Feces; Glucose Tolerance Test; Humans; Intestinal Absorption; Lipase; Lipids; Pancreas; Pancreatic Diseases; Pancreatic Juice; Radionuclide Imaging; Secretin; Selenomethionine; Tolbutamide

Topics: Amylases; Celiac Disease; Cholecystokinin; Duodenum; Fasting; Food; Food Analysis; Humans; Intubation, Gastrointestinal; Liver Diseases; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Secretin; Time; Trypsin

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

Topics: Cholecystokinin; Data Display; Humans; Methionine; Pancreas; Pancreatic Diseases; Radioisotopes; Radionuclide Imaging; Secretin; Selenium

Topics: Amylases; Cholecystokinin; Clinical Enzyme Tests; Duodenum; Feces; Humans; Intestinal Secretions; Intubation, Gastrointestinal; Lipase; Lipids; Pancreas; Pancreatic Diseases; Secretin

Topics: Animals; Bicarbonates; Cholecystokinin; Dogs; Glucose; Humans; Insulin; Insulin Secretion; Islets of Langerhans; Microscopy, Electron; Pancreas; Pancreatic Diseases; Parasympathetic Nervous System; Peptic Ulcer; Secretin; Stomach Neoplasms; Vagotomy; Vagus Nerve

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; 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: Amino Acid Sequence; Aminopeptidases; Amylases; Animals; Carboxypeptidases; Cholecystokinin; Chymotrypsin; Deoxyribonucleases; Endopeptidases; Glucagon; Glucose Tolerance Test; Humans; Insulin; Lipase; Pancreas; Pancreatic Diseases; Pancreatic Elastase; Ribonucleases; Secretin; Tolbutamide; Trypsin

Topics: Amylases; Cholecystokinin; Enzyme Induction; Pancreas; Pancreatic Diseases; Phospholipids; Protein Biosynthesis; RNA; Secretin; Time Factors

Topics: Acetamides; Acetylcholine; Amino Acids; Animals; Antibodies; Bicarbonates; Chemistry Techniques, Analytical; Cholecystokinin; Digestive System; Dogs; Duodenal Ulcer; Enzymes; Gastric Juice; Gastric Mucosa; Gastrins; Gastrointestinal Hormones; Humans; Pancreas; Pancreatic Diseases; Pancreatic Juice; Peptides; Secretin; Sheep; Stimulation, Chemical; Swine

Topics: Aminopeptidases; Amylases; Cholecystokinin; Chymotrypsin; Deoxyribonucleases; Fatty Acids; Feces; Glucose Tolerance Test; Humans; Intestinal Secretions; Isoenzymes; Lipase; Lipids; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Trypsin

Topics: Amylases; Cholecystokinin; Clinical Enzyme Tests; Duodenum; Feces; Humans; Intestinal Secretions; Lipase; Pancreas; Pancreatic Diseases; Secretin; Trypsin

Topics: Amylases; Cholecystokinin; Humans; Lipase; Pancreas; Pancreatic Diseases; Secretin

A secretin-cholecystokinin test was performed in 103 patients, representing both normal and reduced exocrine pancreatic function. The duodenum was intubated with a triple-lumen tube. The gastric and duodenal contents were aspirated separately and sampled in 10-min periods. An inert, water-soluble marker (58Co-vitamin B12 dissolved in isotonic saline) was infused at a constant rate into the duodenum. Exocrine pancreatic secretion was stimulated by continuous intravenous infusion of secretin for 60 min and a combination of secretin and cholecystokinin for another 60 min. The total recovery of the infused marker was 80%. The concentration of marker in the aspirate did not vary significantly between consecutive 10-min periods during the last 20 min of the secretin stimulation period or during the last 50 min of the combined secretin-cholecystokinin stimulation period, indicating a steady secretion rate into the duodenum. By means of the marker concentrations in the aspirate, the duodenal volumes were calculated and found to vary significantly less than the aspirated volumes. This finding demonstrates that the duodenal volume calculated from the recovery of an inert marker is a closer estimate of the true volume than that obtained by the usual aspiration technique without a volume indicator.

Topics: Cholecystokinin; Cobalt Radioisotopes; Duodenum; Gastric Juice; Humans; Infusions, Parenteral; Intestinal Secretions; Methods; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Secretin; Secretory Rate; Vitamin B 12

Topics: Adult; Aged; Celiac Disease; Cholecystokinin; Chymotrypsin; Clinical Trials as Topic; Colonic Diseases, Functional; Feces; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin

Topics: Cell Differentiation; Cholecystokinin; Hormones; Humans; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Pancreatic Function Tests; Signal Transduction

Intracellular Ca(2+)-changes not only participate in important signaling pathways but have also been implicated in a number of disease states including acute pancreatitis. To investigate the underlying mechanisms in an experimental model mimicking human gallstone-induced pancreatitis, we ligated the pancreatic duct of Sprague-Dawley rats and NMRI mice for up to 6 h and studied intrapancreatic changes including the dynamics of [Ca(2+)](i) in isolated acini. In contrast to bile duct ligation, pancreatic duct obstruction induced intra-pancreatic trypsinogen activation, leukocytosis, hyperamylasemia, and pancreatic edema and increased lung myeloperoxidase activity. Although resting [Ca(2+)](i) in isolated acini rose by 45% to 205 +/- 7 nmol, the acetylcholine- and cholecystokinin (CCK)-stimulated calcium peaks as well as the amylase secretion declined, but neither the [Ca(2+)](i)-signaling pattern nor the amylase output in response to the Ca(2+)-ATPase inhibitor thapsigargin nor the secretin-stimulated amylase release were impaired by pancreatic duct ligation. On the single cell level pancreatic duct ligation reduced the percentage of cells in which submaximal secretagogue stimulation was followed by a physiological response (i.e. Ca(2+) oscillations) and increased the percentage of cells with a pathological response (i.e. peak plateau or absent Ca(2+) signal). Moreover, it reduced the frequency and amplitude of Ca(2+) oscillation as well as the capacitative Ca(2+) influx in response to secretagogue stimulation. Serum pancreatic enzyme elevation as well as trypsinogen activation was significantly reduced by pretreatment of animals with the calcium chelator BAPTA-AM. These experiments suggest that pancreatic duct obstruction rapidly changes the physiological response of the exocrine pancreas to a Ca(2+)-signaling pattern that has been associated with premature digestive enzyme activation and the onset of pancreatitis, both of which can be prevented by administration of an intracellular calcium chelator.

Topics: Adenosine Triphosphatases; Amylases; Animals; Calcium; Chelating Agents; Cholecystokinin; Constriction, Pathologic; Egtazic Acid; Flow Cytometry; Male; Mice; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Rats; Rats, Sprague-Dawley; Signal Transduction; Thapsigargin; Time Factors; Trypsinogen

Sepsis in critical illness is associated with the progressive failure of multiple organs. This study aims to establish a correlation between the severity of sepsis and exocrine pancreatic dysfunction.. In a prospective cohort study pancreatic exocrine function was tested by means of a secretin-cholecystokinin test in 21 critically ill, mechanically ventilated patients with sepsis according to criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee (ACCP/SCCM): 11 patients with shock and 10 patients without shock. Data were compared with seven healthy controls.. The volume of duodenal fluid was not statistically different in the three groups. Sepsis patients without shock had significantly reduced content of amylase and chymotrypsin in duodenal juice compared with healthy controls (P < 0.01). Secretion of amylase, chymotrypsin, trypsin (P < 0.01 each) and bicarbonate in duodenal fluid (P < 0.05) was impaired in the septic shock patients when compared with the healthy controls. The content of trypsin was different between sepsis patients and septic shock patients (P < 0.05). Spearman correlation analysis was significant between the amylase secretion and the APACHE III and SOFA scores (P < 0.01). The SOFA score was also related to secretion of trypsin (P < 0.05). In patients on pressor therapy, use of norepinephrine was associated with a significant decrease in bicarbonate secretion (P < 0.05).. Sepsis is associated with secretory pancreatic dysfunction that is worse in septic shock than in sepsis without shock. Impaired exocrine function was significantly correlated to the APACHE III and SOFA scores.

Topics: Adult; Aged; Cholecystokinin; Cohort Studies; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Prospective Studies; Secretin; Sepsis; Shock, Septic

Cholecystokinin (CCK) has been suggested to modulate insulin output. We have shown that Otsuka Long-Evans Tokushima Fatty (OLETF) rats show little or no expression of the CCK-A receptor gene in the pancreas. We examined whether the CCK-A and CCK-B receptor genes are expressed in the islets and the role of CCK-A receptor in insulin secretion. Gene expressions of CCK receptors were determined by the reverse-transcriptase polymerase chain reaction (RT-PCR) followed by Southern blot hybridization and Northern transfer analysis using LETO rats as controls. Pancreatic endocrine function was examined in perfusion (exogenous CCK stimulation) and meal ingestion (endogenous CCK stimulation) studies. CCK-A receptor mRNA was detected in the islets of LETO rats but not OLETF rats. Expression of the CCK-B receptor gene was detected in both strains by RT-PCR. Insulin secretion was impaired in OLETF rats, but the insulin contents of OLETF and LETO rats were not different. No abnormalities were detected histologically in either strain. These results suggest that the occurrence of pancreatic endocrine dysfunction in OLETF rats may be due to a defect in expression of the CCK-A receptor gene, not to insulin deficiency.

Topics: Animals; Base Sequence; Blood Glucose; Blotting, Northern; Cholecystokinin; Diabetes Mellitus, Type 2; Food; Gene Expression; Glucagon; Insulin; Insulin Secretion; Male; Molecular Sequence Data; Pancreatic Diseases; Perfusion; Rats; Receptor, Cholecystokinin A; Receptors, Cholecystokinin; RNA, Messenger

Topics: Accidents, Traffic; Adult; Analgesics; Cellulitis; Cholecystokinin; Female; Gastrointestinal Agents; Humans; Octreotide; Pancreas; Pancreatic Diseases; Pancreatic Pseudocyst; Parenteral Nutrition; Wounds, Nonpenetrating

Application of pancreatic digestive enzymes is indicated in cases of a quantitatively decreased exogenous secretion or an asynchronous secretion of enzymes with regard to the duodenal passage of chyme. A clear indication for therapy is a proven steatorrhea, a relative indication loss weight of and/or uncharacteristic abdominal discomfort in patients with proven pancreatic disease, i.e. chronic pancreatitis. Uncharacteristic abdominal discomfort alone, which is regarded as a consequence of 'maldigestion' without proven pancreatic disease, is not an indication for therapy. To prevent a destruction of exogenously applied lipase by gastric acid and to enable a synchronous gastroduodenal passage of the enzymes together with food, acid-protected micropellets or -tablets with an ideal diameter around 1.4 mm containing high amounts of lipase are requested. In cases of anacidity i.e. gastrectomy or type-A gastritis, lipase rich 'conventional' enzymes applied as granulate are sufficient. Combinations (pancreatic enzymes with bile acids) or fungal lipases have either more side effects (diarrhea) or are less efficient when compared to porcine enzymes. Acid-resistant microbial lipases may be useful in the near future. Application of pure proteases or pancreatic enzymes with high concentrations of proteases as treatment of pain in chronic pancreatitis ('negative feedback regulation') are a rather expensive form of treatment when compared to analgetics and are probably ineffective.

Topics: Cholecystokinin; Enzyme Therapy; Exocrine Pancreatic Insufficiency; Humans; Lipase; Pain Management; Pancreas; Pancreatic Diseases; Pancreatin; Pancreatitis

Bile exclusion from the gut exacerbates pancreatic duct obstruction-induced acute pancreatitis. We hypothesized that obstruction-induced acute pancreatitis involves an increase in circulating cholecystokinin (CCK), as bile and pancreatic juice exclusion from the gut stimulates duodenal CCK release. We studied 54 rats after the following operations: (1) sham operation (n = 18), (2) hepatic bile duct obstruction alone (n = 18), (3) hepatic bile duct and common bile-pancreatic duct obstruction (n = 18). Rats recovered and were killed in subgroups of six rats each at 3, 6, and 18 hr after operation; blood was collected for measurement of plasma CCK and amylase concentrations. Each pancreas was excised, weighed, and processed for histological examination; an acute pancreatitis score was determined. Combined bile and pancreatic duct obstruction induced acute pancreatitis and was associated with a marked increase of circulating CCK concentration. Bile duct obstruction alone did not induce acute pancreatitis but was associated with an increase of circulating CCK of lower magnitude. The time course of circulating CCK increase showed an early peak. These findings support our hypothesis and suggest that CCK plays a role in the pathogenesis of obstruction-induced acute pancreatitis.

Topics: Amylases; Animals; Cholecystokinin; Cholestasis; Constriction, Pathologic; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis; Rats; Rats, Sprague-Dawley

Plasma cholecystokinin (CCK) levels in rats with pancreatic insufficiency induced by a single injection of 50 microliters oleic acid into the pancreatic duct were determined by a sensitive and specific bioassay using the isolated rat pancreatic acini. Treatment with oleic acid significantly decreased pancreatic wet weight within 7 days, which lasted until the end of observation (56 days). Histologic examination revealed the destruction of acinar cells and the epithelium of intra- and interlobular ducts. Plasma CCK bioactivity was significantly increased from the pre-treatment values of 0.8 +/- 0.1pM to 5.1 +/- 1.4pM at 24h after oleic acid treatment. After this peak, plasma CCK levels gradually decreased. Even after 56 days, however, plasma CCK levels in oleic acid-treated rats were significantly high compared with those in control rats. In the present study, plasma CCK levels in rats with chronic pancreatitis did not correlate with the progress of pancreatic insufficiency.

Topics: Animals; Cholecystokinin; Injections; Male; Oleic Acid; Oleic Acids; Pancreatic Diseases; Pancreatic Ducts; Rats; Rats, Wistar

Pancreatic exocrine stimulation by cholecystokinin (CCK) has been implicated in the pathogenesis of experimental acute pancreatitis. Bile exclusion from the gut stimulates duodenal CCK release and exacerbates obstruction-induced acute pancreatitis. Pancreatic and bile duct obstruction increases circulating CCK concentration. We hypothesized that acute pancreatitis induced by pancreatic and bile duct obstruction would be ameliorated when bile was returned to the duodenum. As many small pancreatic ducts drain into the bile duct in rats, preservation of bile flow required the use of a bile shunt. We studied acute pancreatitis and the time course of circulating CCK increase in three groups of rats after: (1) sham operation (dissection, no obstruction), (2) bile and pancreatic duct obstruction, and (3) bile and pancreatic duct obstruction with bile shunt. The rats were killed at 3-, 6-, and 18-hr intervals after operation. Their blood was collected for measurement of CCK, amylase, and bilirubin concentrations. The pancreata were excised, weighed, and processed for histological examination. The shunting of bile back to the duodenum ameliorated the acute pancreatitis along with a simultaneous limitation of the rise in CCK concentration. This suggests that bile duct obstruction, another form of bile exclusion, exacerbates pancreatic duct obstruction-induced acute pancreatitis. The elevation in CCK concentration showed an early peak indicating that the potential role of CCK in the pathogenesis of obstruction-induced acute pancreatitis is predominantly in the early phase of its development.

Topics: Acute Disease; Anastomosis, Surgical; Animals; Bile Ducts, Intrahepatic; Bilirubin; Cholecystokinin; Cholestasis; Constriction, Pathologic; Duodenum; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis; Rats; Rats, Sprague-Dawley; Time Factors

This study was conducted to determine the effects of nicotine inhalation on the onset, progression, and sequential development of pancreatic lesions. Male Sprague-Dawley rats in groups of five were exposed to saline or nicotine aerosol twice daily for 15, 30, 45, and 60 min for 21 days. After sacrifice, blood samples were analyzed for plasma levels of nicotine, glucose, gastrin, and cholecystokinin. Pancreatic tissues were examined for pathological lesions. While there were no significant differences in plasma levels of glucose, gastrin, and cholecystokinin in all groups, there was a steady increase in plasma levels of nicotine with increased exposures to nicotine. Histopathological examination of pancreatic tissue revealed definitive pancreatic injuries that also appeared to be directly correlated with increased duration of nicotine exposure. The pathological changes of the pancreas were confined only to acinar cells of the exocrine pancreas. Two main types of cellular changes were observed: cellular swelling/vacuolation and nuclear condensation/cellular pyknosis. Both of these changes indicated tissue injuries in the pancreas. Transformation of the glandular acini to solid masses of epithelial cells was also observed. The results from our present study strongly suggest that the exocrine pancreas is very sensitive and susceptible to nicotine toxicity. Our data further indicate that early morphological changes in the pancreas induced by nicotine may occur without functional or metabolic alterations; however, such changes could occur at a later stage, when tissue and cellular changes become more extensive.

Topics: Administration, Inhalation; Animals; Blood Glucose; Cell Nucleus; Cholecystokinin; Cytoplasm; Gastrins; Male; Nicotine; Pancreas; Pancreatic Diseases; Rats; Rats, Sprague-Dawley; Vacuoles

The short-term effects of rat pancreatic duct obstruction were evaluated and compared with those recently reported to follow obstruction of the rabbit pancreatic duct. In both species pancreatic edema and hyperamylasemia are noted, and the lysosomal hydrolase cathepsin B is redistributed from the lysosome-enriched to the zymogen granule-enriched subcellular fraction. Theoretically, this redistribution phenomenon might lead to digestive enzyme activation because cathepsin B is known to be capable of activating trypsinogen. The hyperamylasemia and pancreatic edema (but not the cathepsin B redistribution) that follow rat pancreatic duct obstruction were increased by infusion of a submaximally stimulating dose of the cholecystokinin analogue cerulein. Administration of the cholecystokinin-receptor antagonist L-364,718 reduced the hyperamylasemia but did not alter the pancreatic edema or cathepsin B redistribution. These observations indicate that cholecystokinin may modulate some but not all of the effects of duct obstruction. Secretin administration increased the degree of pancreatic edema and had no demonstrable protective effect. The rat duct-obstruction model described in this report may prove particularly useful in future studies designed to clarify the early events underlying the development of acute pancreatitis.

Topics: Amylases; Animals; Benzodiazepinones; Cathepsin B; Ceruletide; Cholecystokinin; Devazepide; Ligation; Male; Pancreatic Diseases; Pancreatic Ducts; Rats; Rats, Inbred Strains; Secretin; Subcellular Fractions; Time Factors

Plasma gastrin and cholecystokinin (CCK) responses were measured after a pancreatoduodenectomy (PD) using the Billroth-I type reconstruction combined with distal partial gastrectomy (standard PD) and combined with preservation of the pylorus and the duodenal bulb (PPPD). Six unoperated patients, 4 men and 2 women, were studied as control subjects. Basal plasma levels of gastrin were significantly higher in controls than in patients who had a standard PD (p less than 0.05) and gastrin responses to a meal were also blunted in these patients. In contrast basal and postprandial levels of gastrin after PPPD were significantly higher than these found in patients with standard PD (p less than 0.05). Postprandial gastrin response after PPPD were similar in pattern to these found in controls. Integrated gastrin release after PPPD was less than that of the control but was significantly greater than that in patients with standard PD. Basal plasma levels of CCK in the patients after the standard PD were significantly lower than in controls and significantly higher postprandial levels of CCK were found after PPPD compared to standard PD (p less than 0.05). However integrated CCK from 0 to 120 minutes were not significantly different between PPPD and standard PD groups. Based on these observations concerning hormonal release of gastrin and CCK, preservation of the stomach and the duodenal bulb appears to be a more physiologic reconstructive procedure than the standard PD. In addition the operation probably has more beneficial effect on the injured pancreas in time.

Topics: Adolescent; Adult; Aged; Cholecystokinin; Eating; Female; Follow-Up Studies; Gastrectomy; Gastrins; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreaticojejunostomy; Postoperative Period; Pylorus; Radioimmunoassay; Radionuclide Imaging

Thin layer urea isoelectric focusing is a powerful tool for a rapid and reproducible high resolution separation of cholecystokinin stimulated human pancreatic proteins. In pancreatic juice of patients without pancreatic disease, 11 main protein bands were separated and distinguished by Coomassie Blue-R 250 staining. A number of faint protein bands divided among the whole pH range demonstrate a wide microheterogeneity of exocrine pancreatic proteins. Secretory protein patterns of patients with chronic pancreatitis are shown to be different from those of patients without pancreatic disease. Significant alterations were found at the acidic protein band region of pI 4.4 to 4.7. In two cases of chronic pancreatitis the IEF pattern was very similar to that obtained by a short time enteropeptidase incubation of pure pancreatic juice from patients without pancreatic disease.

Topics: Cholecystokinin; Humans; Indicators and Reagents; Isoelectric Focusing; Molecular Weight; Pancreatic Diseases; Pancreatic Juice; Proteins; Reference Values

Pancreatic injury was induced to rats with intraperitoneal injection of ethionine 60 mg per 100 g BW twice or three times weekly for 6 weeks. These rats were given 100 mg/kg of Camostate mesilate (CM) via a gastric tube daily for 14 days. CM administration resulted in an increase of pancreatic wet weight, hypertrophy and hyperplasia of acinar cells, and an increase of exocrine pancreatic function. Acini prepared from CM and ethionine-treated rats exhibited increased response to caerulein, but decreased sensitivity to caerulein. The plasma CCK level in rats with CM administration 24 hours later was higher than that without CM administration. However, there were no significant changes in plasma CCK and secretin level thereafter. We concluded that CM had a trophic effect on the pancrease with ethionine-induced pancreatic injury, and CCK was considered playing the same role in injured pancreas as the normal rat pancreas. Studies using CCK receptor antagonist are needed for further clarification.

Topics: Administration, Oral; Amylases; Animals; Cholecystokinin; Esters; Ethionine; Gabexate; Guanidines; In Vitro Techniques; Male; Pancreas; Pancreatic Diseases; Rats; Secretin; Trypsin Inhibitors

In studies on the pathogenesis of ischemic cell injury and of other pancreatic diseases the knowledge of the actual pancreatic energy state is an important factor. Therefore, it would be advantageous to have a simple and inexpensive method to determine this parameter and its alterations in the pancreas. At uniform hormonal stimulation, the extent of exocrine pancreatic secretion showed a clear dependence on energy supply in this organ. The degree of pancreatic juice edema formed after bolus injection of cholecystokinin and secretin at ductal occlusion was found to be the most sensitive and reproducible measure of the functional capacity of the pancreatic energy metabolism. While this parameter can be applied to experimental studies, only, the juice volume secreted could be determined under clinical conditions, too. Both parameters of pancreatic secretion were clearly decreased after preceding short-term ischemia and recovered after an adequate interval of reperfusion.

Topics: Animals; Cholecystokinin; Dose-Response Relationship, Drug; Edema; Energy Metabolism; Female; Ischemia; Pancreas; Pancreatic Diseases; Pancreatic Juice; Rats; Secretin

The results of 407 secretin-pancreozymin tests were analysed by a variety of statistical methods, in an attempt to optimize diagnostic yield. The best diagnostic yield accrued from selection of a point corresponding to 95% specificity and 60% sensitivity on each of two virtually superimposable receiver-operator curves--using either bicarbonate output or a discriminant function derived from multivariate analysis--and the anticipated yield approximated to that realised in a further prospective series of 150 cases. At a 25% hypothetical local prevalence of chronic pancreatic disease (including chronic pancreatitis and pancreatic cancer), the positive predictive value was 80%, the negative predictive value 88% and the efficiency was 86%--values that are not dissimilar to those reported in a study in which both hormones were given simultaneously by constant intravenous infusion for 105 min with multivariate analysis of the results. We conclude that (a) measurement of bicarbonate output in 30 min after an appropriate dose of secretin given as a bolus injection yields results that are comparable to those obtained when secretin and pancreozymin are given by constant intravenous infusion in doses to evoke maximal secretory responses; and (b) the yield of hormone tests using duodenal intubation is far from ideal.

Topics: Cholecystokinin; Humans; Infusions, Intravenous; Multivariate Analysis; Pancreatic Diseases; Reference Values; Secretin

Pancreatic insufficiency was induced in rats by a single injection of 50 microliter oleic acid into the pancreatic duct over a period of 3 min. Exocrine tissue was destroyed within 3-6 days, and after 6 weeks the remaining pancreas equaled 2.7% of the original organ. The rats showed retardation of body weight in spite of normal food intake. After 7 weeks the fecal weight increased by 23%, and the fecal chymotrypsin activity decreased by 90% compared to controls. At this time plasma cholecystokinin (CCK) concentrations were significantly elevated. The amylase content in the remaining pancreas was reduced by 99%, and trypsin content was reduced by 93%. Unstimulated protein discharge from the remnant pancreas in vitro was threefold higher compared to secretion from control tissue. Thus a simple, reproducible model for inducing persistent pancreatic insufficiency was developed. To compensate for the loss of exocrine tissue, the remaining acinar cells adapt by a CCK-mediated increase in protein secretion.

Topics: Adaptation, Physiological; Amylases; Animals; Cholecystokinin; Digestive System; Disease Models, Animal; Male; Oleic Acid; Oleic Acids; Pancreatic Diseases; Rats; Rats, Inbred Strains; Trypsinogen

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

A procedure to collect pure pancreatic juice endoscopically is described which allows an instant estimation of the protein content of the secretion by measuring its absorption at 280 nm. By this the kinetics of protein secretion can already be read from a curve during the collecting procedure, thus avoiding a multitude of small fractions otherwise necessary. Timing and size of the samples are adjusted individually according to the course of protein secretion and not to a rigid regimen. The method described is especially apt to investigations of pancreatic proteins and substances the secretion of which parallels that of protein; e. g. trypsinogen, calcium and zinc, however not sodium and potassium.

Topics: Cholecystokinin; Electrolytes; Endoscopy; Humans; Pancreatic Diseases; Pancreatic Function Tests; Pancreatic Juice; Proteins; Trypsinogen

The evidence is quite solid that a feedback inhibition system of the pancreatic exocrine secretion exists in a number of animal species. Whether or not such a regulatory system is operative in man remains controversial. Studies in normal human subjects which have been interpreted as evidence that such a regulatory system is not present in man suffer from serious flaws in experimental design, such as the inability to completely divert pancreatic enzymes (chymotrypsin, elastase) as important principles in this control mechanism. Studies in both normal human subjects and patients with chronic pancreatitis will be reviewed.

Topics: Cholecystokinin; Duodenum; Homeostasis; Humans; Pancreatic Diseases; Pancreatic Juice; Reference Values; Trypsin

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

To estimate the diagnostic value of elastase output in the duodenal aspirates during a pancreozymin secretin test, elastase as well as amylase, chymotrypsin, trypsin, and lipase was determined in 46 controls and 61 patients with various disease. The elastase output decreased significantly in chronic pancreatitis (mild exocrine insufficiency 13 and advanced eight), pancreatic cancer (n = 10), and liver cirrhosis (n = 14) when compared with the controls. The outputs of the four other enzymes also decreased in chronic pancreatitis and pancreatic cancer, not in liver cirrhosis. Low elastase output was found in four of 13 chronic pancreatitis patients with mild exocrine insufficiency, whereas low outputs of the other enzymes were observed in only one or less of the 13. The ratio of elastase to amylase alone was significantly lower in the pancreatic diseases. The results suggest that elastase is the most susceptible enzyme to pancreatic dysfunction and that its output and its ratio to amylase output provide a valuable index to assess the enzyme secretory capacity in the pancreatic diseases.

Topics: Cholecystokinin; Duodenum; Female; Humans; Intestinal Secretions; Male; Pancreas; Pancreatic Diseases; Pancreatic Elastase; Pancreatic Function Tests; Reference Values

Intestinal adaptation has been studied in rats with pancreatic atrophy induced by feeding a copper-deficient diet and penicillamine and in rats with carbohydrate maldigestion induced by feeding of an alpha-glucosidase inhibitor (acarbose). Pancreatic atrophy led to a significant increase of weight, protein, and DNA content as well as specific activities and total amounts of the enzymes sucrase and maltase in the distal but not in the proximal part of the small intestine. Plasma levels of CCK and GIP were significantly higher in rats with pancreatic atrophy, whereas plasma levels of gastrin and insulin were lower. Tissue concentrations of gastrin in the antrum and GIP in duodenum and jejunum were unchanged. Duodenal CCK and jejunal substance P, somatostatin, and VIP and ileal substance P and somatostatin were significantly decreased in rats with acinar atrophy. Glucosidase inhibition by acarbose feeding led to weight increase of the small intestine and cecum. This was more marked when acarbose was fed together with a fiber-free diet. Under these conditions the protein and DNA content also increased significantly in both gut segments and maltase and sucrase content predominantly in the distal part. Insulin plasma concentration decreased significantly in the acarbose-fed groups, whereas GIP, gastrin, and CCK plasma concentrations remained unchanged. After fiber-rich diet tissue concentrations of gastrin in the antrum and insulin in the pancreas were significantly higher and GIP concentrations in the duodenum and jejunum significantly lower than after fiber-free diet. Acarbose increased the pancreatic insulin concentration only in the fiber-free group and did not influence gastrin and GIP concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acarbose; Adaptation, Physiological; alpha-Glucosidases; Animals; Atrophy; Cholecystokinin; Copper; Diet; Digestive System Diseases; DNA; Gastric Inhibitory Polypeptide; Gastrins; Glucosidases; Glycoside Hydrolase Inhibitors; Insulin; Intestinal Absorption; Intestine, Small; Male; Oligosaccharides; Pancreatic Diseases; Penicillamine; Proteins; Rats; Rats, Inbred Strains; Sucrase; Trisaccharides

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

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

Topics: Adult; Aged; Arteriosclerosis; Cholecystokinin; Duodenum; Humans; Intestinal Secretions; Liver Cirrhosis; Middle Aged; Pancreatic Diseases; Pancreatic Elastase; Radioimmunoassay; Secretin

Topics: Amylases; Cholecystokinin; Duodenum; Humans; Intestinal Secretions; Pancreatic Diseases; Pancreatic Juice; Ribonucleases; Secretin; Trypsin

Pancreatic responses to submaximal doses of synthetic secretin (125 ng/kg) and cholecystokinin octapeptide (50 ng/kg) were investigated in controls and patients with pancreatic disease. Doses of stimulants were chosen from dose-response experiments to avoid supramaximal amounts which inhibited the pancreatic response. Injection of secretin resulted in duodenal juice in less trypsin but more lipase activity than that elicited by cholecystokinin octapeptide. The increase of amylase was about the same. Diagnostic efficacy of pancreatic responses to the individual hormones was similar. An overall evaluation of the results seems to be the most reliable method for diagnostic purposes.

Topics: Amylases; Cholecystokinin; Dose-Response Relationship, Drug; Duodenum; Hormones; Humans; Intestinal Secretions; Lipase; Pancreatic Diseases; Secretin; Sincalide; Trypsin

Topics: Cholecystokinin; Duodenum; Humans; Intestinal Secretions; Pancreatic Diseases; Pancreatic Elastase; Secretin

Topics: Cholecystokinin; Humans; Pancreatic Diseases; Parotid Gland; Saliva

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

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

The intraductal secretin test is an important diagnostic study. It enables the physician to determine the pancreatic secretory function in patients with known pancreatitis and to confirm the diagnosis of pancreatitis in many patients with indeterminate upper abdominal pain in whom ERCP and other diagnostic studies are normal. The IDST also provides the endoscopist and biochemist a new means to establish discriminating tests in differential diagnosis of pancreatic cancer and pancreatitis and to study the physiology of pancreatic secretion.

Topics: Bicarbonates; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Diagnosis, Differential; Humans; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Proteins; Secretin; Secretory Rate

Topics: Adult; Aged; Cholecystokinin; Female; Follow-Up Studies; Glycoside Hydrolases; Humans; Isoamylase; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Secretin

In a prospective study of 60 patients undergoing investigation for possible exocrine pancreatic disease the fluorescein-dilaurate test was compared with the secretin-cholecystokinin (CCK) test. Forty one patients had a normal response to secretin-CCK, 14 patients had abnormal responses and in five patients the results were equivocal. Taking the secretin-CCK test as the diagnostic criterion, the fluorescein-dilaurate test had a sensitivity of 100% and a negative predictive value of 100%. There was a 54% false-positive rate. The fluorescein-dilaurate test is easy to perform and is a useful screening test for pancreatic exocrine insufficiency.

Topics: Adolescent; Adult; Aged; Cholecystokinin; Female; Fluoresceins; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Function Tests; Prospective Studies; Secretin

The pancreolauryl test is marketed as a tubeless test of pancreatic function based on the specific splitting by pancreatic esterase of orally administered fluorescein dilaurate. We have evaluated the test in 50 patients, all of whom had at least one other pancreatic function test (secretin-pancreozymin, Lundh, BT PABA/14C index). The sensitivity of the pancreolauryl test was 75% if equivocal results (T/K 20-30) were excluded and 77% if the equivocal results were included amongst the abnormal results - figures which were similar to those obtained for the other three function tests. However, the specificity of the pancreolauryl test was 60% if equivocal results were excluded, decreasing to only 39% if equivocal results were considered to be abnormal. The false-positive tests chiefly occurred in patients who had previously undergone gastric or biliary by-pass, or vagotomy and cholecystectomy (BT PABA/14C test normal). These data, and the known dependence of esterase activity on bile salts, suggest that the pancreolauryl test assesses the combined functional efficacy of secreted esterase and bile salts. Despite the test's high sensitivity, its low specificity makes it unreliable as a test of pancreatic function per se. The pancreolauryl test may be particularly useful in evaluating patients with bile-pancreatic juice admixture problems.

Topics: Bile Acids and Salts; Cholecystokinin; Esterases; Humans; Pancreatic Diseases; Pancreatic Function Tests; Pancreatitis; Secretin

A new test of intraluminal fat digestive activity is proposed for which a mixed triglyceride, 1,3-dioleyl-2-14C-decanoyl glycerol, was used. 29 normal subjects, 14 patients with proven chronic pancreatitis, 10 pancreatectomy, 12 villus atrophy and 8 bile acid-deficient patients were studied. The mean 14CO2 excretion in breath, expressed as the 10th-hour cumulative percentage of the administered dose, was 68.3% in the normal subjects, and only 32.9% in patients with pancreatic disease. There was almost no overlap between the normal subjects and the patients with proven organic disease. The test also allowed the detection of functional pancreatic insufficiency, due to impaired pancreatic stimulation in case of gluten enteropathy and severe malabsorption.

Topics: Adult; Breath Tests; Carbon Dioxide; Cholecystokinin; Clinical Enzyme Tests; Female; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatectomy; Pancreatic Diseases; Pancreatic Extracts; Pancrelipase; Secretin; Triglycerides

Topics: Cholecystokinin; Gastric Juice; Humans; Pancreatic Diseases; Secretin

Sixty-five patients with possible pancreatic disease or long-lasting upper abdominal symptoms were examined by means of the secretin-CCK test and hypotonic duodenography. Both examinations were performed after one duodenal intubation. In patients with pancreatitis functional abnormalities were revealed in 85 per cent while the duodenography was abnormal in 43 per cent. In patients with carcinoma, 77 per cent had abnormal exocrine pancreas function and 70 per cent had abnormalities demonstrated at duodenography. The value of the two examinations for assessment of patients with upper abdominal symptoms and pancreatic disease is discussed.

Topics: Adult; Aged; Bicarbonates; Cholecystokinin; Duodenum; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Radiography; Secretin

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

In many ways diagnosis of pancreatic disorders in children is difficult. Since pancreatic parameters are age-dependent, reliable laboratory parameters are not easily established. Children are less likely than adults to endure tolerance tests and invasive test methods should therefore be used only in special situations. Estimation of chymotrypsin in faeces seems to be an earlier indicator of pancreatic insufficiency than the PABA-peptide-test. A secretin-pancreozymin test can only be advised for first diagnosis after screening has repeatedly indicated pathological values and malabsorption has more or less been ruled out. A threefold rise in serum amylase values - matched for age - suggests pancreatitis and sonography should then be applied to obtain further clarification.

Topics: 4-Aminobenzoic Acid; Age Factors; Amylases; Child; Child, Preschool; Cholecystokinin; Chymotrypsin; Exocrine Pancreatic Insufficiency; Feces; Humans; Infant; Infant, Newborn; Pancreatic Diseases; Pancreatitis; Secretin

The pancreas can be studied for obstructive disease by measuring serum lipase levels in the two stage provocative test. The test is nonspecific but noninvasive and applicable to all stages of pancreatic diseases. In this test, the pancreas is stimulated twice in two hour intervals before measuring the serum enzyme levels: first, with pancreozyin and secretin--the stage 1 test and, second, with pancreozymin, secretin, betazole hydrochloride and morphine sulfate--the stage 2 test. Among the pancreatic enzymes measured, lipase was most reliable. Serum lipase level elevation in the stage 1 test indicates a pancreatic abnormality and it completes the test. Patients who fail to respond to the stage 1 test have either a normal pancreas or pancreatic insufficiency and need the stage 2 test for differential diagnosis. In the stage 2 test, the serum lipase level is elevated in patients with a normal pancreas but not in those with pancreatic insufficiency. As a preliminary study, ten patients with carcinoma of the pancreas, two with pancreatitis and ten in the control group were studied. All patients with a known pancreatic disease demonstrated an abnormality in the test. Two of ten in the control group also had abnormal results. The two stage provocative test may be used prior to undertaking more invasive examinations, such as an arteriogram, in patients who are suspected of having pancreatic disease, yet other tests have failed to indicate it.

Topics: Amylases; Betazole; Cholecystokinin; Chymotrypsin; Clinical Enzyme Tests; Female; Humans; Lipase; Male; Morphine; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin; Trypsin

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: Animals; Cats; Cholecystokinin; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Secretin

Topics: Cholecystokinin; Humans; Pancreas; Pancreatic Diseases; Pancreatic Function Tests; Secretin

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

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

Human pancreatic Deoxyribonuclease I (DNase I), inhibitor was partially purified from duodenal juice of healthy subjects collected in the Pancreozymin-Secretin test, by a procedure which included ammonium sulfate fractionation, DEAE cellulose fractionation, Sepharose 4B affinity chromatography, and gel filtration. The final preparation inhibited DNase I only, and had no inhibitory activity on pancreatic RNase, and trypsin. The inhibitor had a molecular weight of approximately 40,000, as determined by gel filtration, and showed the same mobility as skeletal muscle actin on SDS gel electrophoresis. Then clinical studies were made on the DNase I inhibitor in duodenal juice obtained after administration of Pancreozymin and Secretin to patients with various pancreatic diseases. In patients with suspected chronic pancreatitis with whom the ordinary test, containing the assay of the total volume, amylase output and maximum bicarbonate concentration of duodenal juice had produced normal results, the DNase I inhibitor output was observed to be higher than that in control subjects. While it was lower in patients with confirmed chronic pancreatitis than in control subjects. There results imply that DNase I inhibitor output may be an indicator of the pancreatic inflammation state and be useful for the early detection of pancreatic diseases.

Topics: Cholecystokinin; Chromatography, DEAE-Cellulose; Enzyme Inhibitors; Humans; Micrococcal Nuclease; Pancreas; Pancreatic Diseases; Secretin

Topics: Achlorhydria; APUD Cells; Apudoma; Carcinoid Tumor; Carcinoma; Cholecystokinin; Diarrhea; Endocrine System Diseases; Humans; Hypokalemia; Malignant Carcinoid Syndrome; Neoplasms; Pancreatic Diseases; Paraganglioma; Paraneoplastic Endocrine Syndromes; Peptides; Prostaglandins E; Somatostatin; Syndrome; Thyroid Neoplasms; Vasoactive Intestinal Peptide

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Biliary Tract Diseases; Cholecystokinin; Evaluation Studies as Topic; Humans; Liver Diseases; Pancreatic Diseases; Pancreatic Function Tests; para-Aminobenzoates; Secretin; Tyrosine

The release of enterokinase into human duodenal fluid was studied after intravenous injections of secretin and cholecystokinin-pancreozymin (CCK-PZ). In five control subjects there was a significant release of the enzyme after stimulation with either hormone. A similar release of enterokinase was observed after hormonal stimulation in three patients with total biliary obstruction and in four patients with pancreatic exocrine insufficiency. These results suggest that the hormone-mediated release of enterokinase is independent of bile salts and trypsin in man. This release of enterokinase into duodenal fluid may be physiologically important in protein digestion.

Topics: Bile Acids and Salts; Biliary Tract Diseases; Cholecystokinin; Duodenum; Endopeptidases; Enteropeptidase; Humans; Intestinal Secretions; Pancreas; Pancreatic Diseases; Secretin; Trypsin

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

A follow-up investigation of 20 patients, surgically treated for acute haemorrhagic necrotising pancreatitis, was performed in an average of 2 3/4 years after the operation. Twelve patients showed manifest diabetes mellitus, four further cases had a suspicious oral glucose tolerance test. Only one patient was insulin dependent. A secretin-pancreozymin test performed in 15 patients showed a dissociated or global pancreatic insufficiency in 13 cases. The extent of the endocrine and exocrine functional disturbance did not correlate with the extent of surgery. Postoperative functional defects were readily improved therapeutically in most cases. Only in patients who continued to consume alcohol were there digestive disturbances. The results indicate that the functional state of the remaining pancreas does not only depend on the extent of surgery but also on the extent of already existing or persisting toxic inflammatory damage and on the regenerative capacity of the remaining parenchyma.

Topics: Acute Disease; Cholecystokinin; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Necrosis; Pancreatic Diseases; Pancreatitis; Postoperative Complications; Secretin

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

Topics: Cholecystokinin; Female; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin

The viscosity of duodenal juice obtained during the pancreocymin secretin test from patients with excretory pancreas insufficiency was significantly higher compared to the viscosity of duodenal secretions from a control group or from patients with gall bladder stones. Since the viscosity was inversely related to the total volume as well as the bicarbonate and trypsin concentrations, it is concluded that the increased viscosity is due to a reduction in the secretory activity of the pancreas. The viscosity measurements found for patients with cholelithiasis reflects merely the higher viscosity of the gall bladder bile.

Topics: Adult; Cholecystokinin; Cholelithiasis; Duodenum; Female; Humans; Intestinal Secretions; Male; Pancreas; Pancreatic Diseases; Secretin; Viscosity

In medical practice, diagnostic and therapeutic aspects of gastrointestinal hormones attract interest. Gastrin--in the form of pentagastrin--can be used for gastric secretory analysis and, in the analysis of exocrine pancreatic function, secretin and cholecystokinin-pancreozymin can be employed as stimulants. Diagnosis of hormone-producing tumors is possible by radioimmunological determination of serum levels of the hormone in question: so, dramatically high gastrin levels can be found in the Zollinger-Ellison syndrome while in the Verner-Morrison syndrome, VIP (vasoactive intestinal peptide) values are significantly elevated.--The therapeutic use of gastrointestinal hormones (gastrin, secretin) is waiting in the wings.

Topics: Cholecystokinin; Duodenal Ulcer; Gastrointestinal Diseases; Gastrointestinal Hormones; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Pentagastrin; Secretin; Vasoactive Intestinal Peptide

Topics: Cholecystokinin; Humans; Pancreas; Pancreatic Diseases; Pancreatic Ducts; Radiography; Radioisotopes; Radionuclide Imaging; Secretin; Selenium

Fecal chymotrypsin (CT) activities were determined in 149 randomly collected fecal specimens of 80 patients in whom the pancreatic function had been tested by a secretin-cholecystokinin test. There was a significant correlation between fecal CT activities and outputs of trypsin (r = 0.3451, p less than 0.01) and amylase (r = 0.3285, p less than 0.01) in duodenal juice. Fecal CT activities were normal in all patients who--based upon enzyme outputs in duodenal juice after stimulation with secretin and CCK/PZ--were classified as 'borderline cases', in most patients with 'low-normal' pancreatic function, and in a significant number of patients with established insufficiency of exocrine pancreas. On the other hand, fecal CT activities were abnormal in patients with severely impaired output of trypsin in duodenal juice, and only 7% of the fecal specimens from patients with established normal function of exocrine pancreas had abnormal low CT activities. It is concluded that the sensitivity of the fecal enzyme method is rather low as compared to the secretin-cholecystokinin test, but that fecal CT determinations give valuable diagnostic information in patients with more pronounced insufficiency of the exocrine pancreas.

Topics: Amylases; Cholecystokinin; Chymotrypsin; Duodenum; Feces; Humans; Pancreas; Pancreatic Diseases; Secretin; Trypsin

A normal exocrine pancreatic function was demonstrated by the secretin-pancreozymin-test in five patients with Wilson's disease either without (n = 2) or with cirrhosis of the liver but without portal hypertension (n = 3). In another patient with cirrhosis of the liver without portal hypertension the pancreas was normal at post mortem examination. In two patients with cirrhosis of the liver and portal hypertension bicarbonate (n = 1) and amylase secretion (n = 2) were diminished. The regression of portal hypertension under therapy with penicillamine in one of the latter cases was paralleled by the return to normal of exocrine pancreatic function. It is concluded that exocrine pancreatic insufficiency in Wilson's disease is dependent on the development and the progression of chirrhosis of the liver and not due to a primary manifestation of the disease itself.

Topics: Adolescent; Adult; Amylases; Bicarbonates; Child; Cholecystokinin; Female; Hepatolenticular Degeneration; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Pancreatic Diseases; Secretin

Topics: Acute Disease; Aged; Aprotinin; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatitis; Secretin; Ultrasonography

Topics: Amylases; Biliary Tract Diseases; Cholecystokinin; Duodenum; Humans; Intestinal Secretions; Liver Diseases; Pancreatic Diseases; Ribonucleases; Secretin

Topics: Adolescent; Adult; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin

Topics: Adult; Aged; Bicarbonates; Cholecystokinin; Duodenum; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin; Stimulation, Chemical

Topics: Adolescent; Child; Cholecystitis; Cholecystokinin; Duodenal Diseases; Duodenal Ulcer; Enteritis; Humans; Pancreatic Diseases; Pancreatitis

The pancreatic excretion test with a weak acid of 5, 5-dimethyl-2,4-oxazolidinedione (DMO) was performed concomitantly with the pancreozymin-secretin test in 28 patients with pancreatolithiasis, 14 patients with pancreatic carcinoma, and 67 healthy subjects. The DMO concentration and total output of duodenal content after secretin stimulation, when corrected to the simultaneously determined plasma DMO concentration, were significantly reduced in the patients. While the pancreozymin-secretin test was abnormal in 96% of patients with pancreatolithiasis and in 86% of those with pancreatic carcinoma, the pancreatic DMO excretion test gave abnormal results in 100% of the patients. This suggests that the new test may well become effective in detecting early stages of pancreatic disease including carcinoma and chronic pancreatitis.

Topics: Calculi; Cholecystokinin; Dimethadione; Duodenum; Humans; Oxazoles; Pancreatic Diseases; Pancreatic Neoplasms; Secretin; Trimethadione

Topics: Adolescent; Adult; Aged; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreatic Diseases

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

Topics: Celiac Disease; Cholecystokinin; Gastrointestinal Diseases; Humans; Pancreatic Diseases

In vitro and in vivo studies determined the effect of digestive enzymes on substrate-coated barium sulfate tablets. Fragmentation of the barium tablet core was detected radiographically after enzymatic digestion of the substrate material occurred. Preliminary studies in humans suggest that such tablets may be used in the diagnosis of pancreatic exocrine insufficiency.

Topics: Adult; Animals; Barium Sulfate; Cholecystokinin; Dogs; Enzymes; Humans; Male; Palmitates; Pancreatic Diseases; Pilot Projects; Plant Proteins; Radiography; Starch; Stimulation, Chemical; Tablets, Enteric-Coated

The parotid saliva test was performed in 146 subjects, including 48 patients with pancreatic disorders, 82 with nonpancreatic disorders and 16 healthy persons. The following results were obtained: 1. The salivary output as well as the maximum bicarbonate concentration and amylase content in the parotid saliva of patients with pancreatic disorders were significantly less than those of patients with nonpancreatic disorders. 2. An abnormal saliva test was found in 83.3% of the patients with the pancreatic disorders. 3. Comparison was made of the parotid saliva test with the pancreozyminsecretin test in regard to diagnostic reliability in 44 subjects, including 22 with pancreatic disorders and 22 with nonpancreatic disorders. The data indicated that, in this series, an abnormal parotid saliva test was 88.6% accurate in diagnosing pancreatic disorders, whereas positive pancreozymin-secretin was only 65.9%.

Topics: Amylases; Bicarbonates; Cholecystokinin; Clinical Enzyme Tests; Humans; Methods; Pancreatic Diseases; Parotid Gland; Saliva; Secretin; Secretory Rate

Topics: Cholecystokinin; Humans; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin

This paper deals with a pancreatic function test with the submaximal dose of secretin given by continuous infusion after injection of cholecystokinin-pancreozymin (CCK-PZ) in the submaximal dose. The active elimination of bladder bile by CCK-PZ pretreatment decreased the influence of biliary contamination, and the volume output and the bicarbonate concentration were stabilized by the continuous infusion of secretin. As a result, the coefficients of variation in the volume output and the bicarbonate concentration were calculated to be about 15 and about 5%, respectively. These variations were considerably smaller than those obtained in the standard secretin test. Therefore, the present study is expected to improve the diagnostic means for pancreatic excretory dysfunction.

Topics: Amylases; Bicarbonates; Cholecystokinin; Female; Humans; Male; Methods; Pancreas; Pancreatic Diseases; Secretin

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

Effects of irradiation on the pancreas was studied in 6 dogs receiving a dose equivalent to the biologic effect of 4000 R/6 weeks (with a nominal stnadard dose of 1175 rets) given to patients with Hodgkins disease. After control secretory, histologic and pancreatographic studies, 6 Thomas fistula dogs were subjected to 2400 R tumor dose over two weeks. There was a biphasic response to secretin alone or secretin with cholecystokininpancreozymin. An initial hypersecretion occurred at 2 weeks --volume was increased, but bicarbonate and enzyme output remained unchanged. Thereafter there was a progressive reduction in volume, bicarbonate and enzyme outputs ( greater than 90% after 3 months). Histology showed early ductal reduplication but with progressive fibrosis, features compatible with chronic pancreatitis. Pancreatic insufficiency may contribute to post-irradiation gastrointestinal symptomatology. Close field irradiation of the pancreas results in actual destruction of the parenchyma.

Topics: Animals; Bicarbonates; Cholecystokinin; Disease Models, Animal; Dogs; Female; Male; Pancreas; Pancreatic Diseases; Pancreatic Juice; Radiation Dosage; Radiation Injuries, Experimental; Secretin

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

Topics: Adolescent; Adult; Aged; Cholecystokinin; Female; Humans; Male; Methods; Middle Aged; Pancreatic Diseases; Radioisotopes; Secretin; Selenium

Different methods available for investigating patients for pancreatic disease are discussed. They first include measurement of pancreatic enzymes in biological fluids. Basal amylase and/or lipase in blood are truly diagnostic in acute pancreatitis but their utility is low in chronic pancreatic diseases. Evocative tests have been performed to increase the sensitivity of blood enzyme measurement. The procedure is based on enzyme determination following administration of pancreozymin and secretin, and offers a valuable aid in diagnosis of chronic pancreatitis and cancer of the pancreas. They are capable of discerning pancreatic lesions but are not really discriminatory because similar changes are observed in both diseases. The measurement of urinary enzyme levels in patients with acute pancreatitis is a sensitive indicator of disease. The urinary amylase excretion rises to abnormal levels and persists at significant values for a longer period of time than the serum amylase in acute pancreatitis. The fractional urinary amylase escretion seems to be more sensitive than daily urinary measurement. The pancreatic exocrin function can be assessed by examining the duodenal contents after intravenous administration of pancreozymin and secretin. Different abnormal secretory patterns can be determinated. Total secretory deficiency is observed in patients with obstruction of excretory ducts by tumors of the head of the pancreas and in the end stage of chronic pancreatitis. Low volume with normal bicarbonate and enzyme concentration is another typical pattern seen in neoplastic obstruction of escretory ducts. In chronic pancreatitis the chief defect is the inability of the gland to secrete a juice with a high bicarbonate concentration; but in the advanced stage diminution of enzyme and volume is also evident. Diagnostic procedures for pancreatic diseases include digestion and absorption tests. The microscopic examination and chemical estimation of the fats in stool specimens in different conditions of intake are still important screening tests. Isotopic estimates of steatorrhea and distinction between labeled triolein and oleic acid absorption do not provide greater diagnostic discrimination than traditional procedures. 131I labeled proteins permit a good evaluation of a negative nitrogen balance. Sophisticated procedures to estimate exocrine pancreatic insufficiency are based on the study of endoluminal digestive processes at several times and different level of the sm

Topics: Amylases; Cholecystokinin; Clinical Enzyme Tests; Humans; Insulin; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin

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

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

Topics: Cholecystokinin; Gastrins; Humans; Pancreas; Pancreatic Diseases; Pancreatic Hormones; Pancreatic Neoplasms; Secretin

Dterminations of 75selenium radioactivity and pancreatic enzyme in duodenal aspirate were carried out in 50 patients after i. v. injection of selenomethionine-75Se. After standardized excitation of the pancreas with pancreozymin-secretin, a significant correlation (r = 0.654) between excreted 75Se radioactivity and trypsin production could be established. The test is suitable for the recording of exocrine pancreas function while avoiding expensive enzymatic methods. The combined use of pancreas scintigraphy--using the double radionuclide substraction technique-with the radioselenomethionine test (RSMT) provides comprehensive diagnostic information on the morphology and function of the pancreas.

Topics: Amylases; Bicarbonates; Blood; Cholecystokinin; Diagnostic Errors; Duodenum; Humans; Hydrogen-Ion Concentration; Intestinal Secretions; Kinetics; Methionine; Methods; Pancreatic Diseases; Radioisotopes; Secretin; Selenium; Trypsin

Ten patients with pancreolithiasis and ten controls underwent a 110-minute pancreozymin-secretion test in which post-pancreozymin collection periods were prolonged to 30 minutes. Gamma-Glutamyl transpeptidase concentrations and outputs of duodenal aspirate in response to pancreozymin and to secretin were greatly increased in patients with pancreolithiasis. No correlation was noted between gamma-glutamyl transpeptidase and bile pigment concentrations. The mean concentrations and outputs of amylase in disease were much less than those in control subjects throughout the test. Two categories of pancreolithiasis were distinguished with respect to the distribution and size of the calculi and amylase secretion. We suggest that, in pancreolithiasis, there is an increase in ductal or centroacinar cell mass.

Topics: Adult; Aged; Amylases; Bile Pigments; Biliary Tract; Calculi; Cholecystokinin; Duodenum; Female; gamma-Glutamyltransferase; Humans; Intestinal Secretions; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin; Time Factors

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

The use of multivariate nonlinear discriminant analysis raised the rate of correct classification for 585 pancreatic function tests from 84 percent by the doctor to 93 percent by computer analysis. In addition to the "normal" and "pancreatic" disease groups, a group of 388 patients was found in whom secretion levels were neither normal nor typical of pancreatic disease. For this group, nonpancreatic gastroenterologic disease was established with a diagnostic accuracy of 98 percent. Representation of secretion data by Andrews' method for the differentiation of pancreatitis from carcinoma allows moderately sensitive but highly specific testing.

Topics: Cholecystokinin; Diagnosis, Computer-Assisted; Humans; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin; Stimulation, Chemical

The appearance of radioselenium in the protein fraction of duodenal aspirates has been studied after an intravenous injection of 75-Se-selenomethionine. The continuous flow of pancreatic juice was stimulated by pancreozymin at 120 minutes and by secretin at 140 minutes. A good distinction between normal subjects and patients with pancreatic disease was obtained by measuring 75-Se-radioactivity in the protein fraction of duodenal aspirates; either cumulative radioactivity during the combined 80-minute post-pancreozymin-secretin period, or maximum 75-Se-specific activity during the postsecretin period was used as an index. The test presented here might be a useful and sufficiently reliable method for detecting abnormal pancreatic exocrine function. This test can be performed along with the conventional pancreozymin-secretin test, serum enzyme response to pancreozymin and secretin, and pancreatic scintiscanning.

Topics: Amylases; Cholecystokinin; Duodenum; Humans; Pancreas; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Radionuclide Imaging; Secretin; Selenium; Selenomethionine

Daily pancreatic flow and daily outputs of bicarbonate and amylase in pure pancreatic juice were observed in 15 postoperative patients who underwent upper abdominal surgery. Exocrine pancreatic secretion under the stimulation by enodgenous or exogenous hormones was well correlated with the extent of pancreatic fibrosis estimated by the histometrical treatment. Exocrine pancreatic secretion in Billroth II type of gastrectomy was depressed to 60-70% of the patients' with Billroth I type of gastrectomy. In distal pancreatectomy the depression in the exocrine pancreatic secretion almost corresponded with the resected volume of pancreas. Exocrine pancreatic secretion in pancreatodoudenectomy was highly depressed beyond the expected value from the resected volume and fibrosis of the pancreas. This was interpreted as partly due to the elimination of hormonal mechanism by duodenectomy and partly due to the denervation of the secretory fibers by surgical manipulation.

Topics: Adult; Amylases; Bicarbonates; Biliary Tract Diseases; Cholecystokinin; Duodenum; Female; Gastrectomy; Humans; Male; Middle Aged; Pancreas; Pancreatectomy; Pancreatic Diseases; Pancreatic Juice; Stomach Neoplasms

Topics: Cholangiography; Cholecystokinin; Endoscopy; Humans; Liver; Liver Diseases; Pancreas; Pancreatic Diseases; Secretin

Topics: Carcinoembryonic Antigen; Cholecystokinin; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Animals; Cholecystokinin; Dietary Fats; Dose-Response Relationship, Drug; Duodenum; Gastric Juice; Gastric Mucosa; Gastrins; Gastrointestinal Diseases; Gastrointestinal Hormones; Histamine; Humans; Pancreatic Diseases; Pancreatic Juice; Secretin

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

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

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

The radioactivity in the duodenal juice following the intravenous injection of 75Se-1-selenomethionine was measured in 17 normal subjects and in 14 patients with exocrine pancreatic insufficiency. The mean values of radioactivity were significantly lower during certain periods of the investigation in the patients with pancreatic insufficiency as compared with the normal subjects. The individual values, however, scattered widely and the standard deviations were large. There was a highly significant correlation between the volume of duodenal juice and the 75Se radioactivity, but no significant correlation was established between the duodenal juice radioactivity and bicarbonate or enzyme concentration i.e. specific parameters of exocrine pancreatic function. It is possible that observation period may bring less equivocal results, but this appears of doubtful practicability. Measurement of the 75Se-1-selenomethione radioactivity in the duodenal juice is only an indirect indicator of exocrine pancreatic function. It does not appear to represent any significant advance in the diagnosis of pancreatic insufficiency, since the information provided by these older-established methods is more reliable and is obtained within a similar space of time.

Topics: Cholecystokinin; Duodenum; Humans; Methods; Pancreatic Diseases; Radioisotopes; Secretin; Selenium; Time Factors

Topics: Cholecystokinin; Diabetes Mellitus, Type 1; Gastrectomy; Humans; Pancreas; Pancreatic Diseases; Pancreatitis; Secretin; Stimulation, Chemical

Topics: Cholecystokinin; Humans; Pancreatic Diseases; Pancreatic Neoplasms; Radionuclide Imaging; Secretin

Topics: Adolescent; Adult; Aged; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases

Topics: Cholecystokinin; Chymotrypsin; Duodenum; Endoscopy; Humans; Intubation, Gastrointestinal; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Radiography; Trypsin

Topics: Age Factors; Body Height; Body Weight; Child; Cholecystokinin; Cystic Fibrosis; Female; Humans; Infant; Male; Pancreas; Pancreatic Diseases; Secretin

Topics: Adolescent; Adult; Aged; Anilides; Arginine; Benzyl Compounds; Cholecystokinin; Duodenum; Female; Humans; Male; Middle Aged; Nitro Compounds; Pancreatic Diseases; Secretin; Tosyl Compounds; Trypsin

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: Amylases; Cholecystokinin; Chymotrypsin; Clinical Enzyme Tests; Humans; Lipase; Pancreatic Diseases; Trypsin

Topics: Adult; Aged; Cholecystokinin; Clinical Enzyme Tests; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Juice; Secretin; Stimulation, Chemical; Zinc

Pancreatic volume, bicarbonate and enzyme secretion were studied after sequential and after simultaneous secretin and cholecystokinin (CCK) stimulation and the results compared. No statistical difference between sequential or simultaneous stimulation was noted. A comparison of secretin alone with simultaneous secretin plus cholecystokinin stimulation showed that the combination yielded a significantly higher trypsin concentration. Volume and bicarbonate were unchanged.

Topics: Bicarbonates; Cholecystokinin; Humans; Pancreas; Pancreatic Diseases; Secretin

Topics: Adult; Aged; Cholecystokinin; Cholelithiasis; Duodenal Diseases; False Negative Reactions; False Positive Reactions; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Parotid Gland; Saliva; Secretin

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

Topics: Adult; Amylases; Ceruletide; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin

Topics: Amylases; Animals; Cholecystokinin; Clinical Enzyme Tests; Humans; Pancreatic Diseases; Rats; Secretin; Trypsin

Topics: Amylases; Cholecystokinin; Clinical Enzyme Tests; Humans; Middle Aged; Pancreatic Diseases; Secretin

Topics: Atropine; Cholecystokinin; Humans; Methionine; Methods; Morphine; Pancreatic Diseases; Radionuclide Imaging; Selenium; Subtraction Technique

Topics: Cholecystokinin; Cholelithiasis; Duodenal Ulcer; Esophageal Achalasia; Gastrins; Gastritis; Gastrointestinal Hormones; Humans; Pancreatic Diseases; Peptic Ulcer; Secretin; Stomach Neoplasms; Stomach Ulcer

The hormones secretin and cholecystokinin-pancreozymin (CCK) have been shown to release brush-border alkaline phosphatase into the small-intestinal lumen in the human subject. In contrast to the disaccharidases, large amounts of alkaline phosphatase are present in human duodenal juice. The range has been established in normal subjects. Following the intravenous administration of both secretin and CCK-pancreozymin there is a large rise in the output of alkaline phosphatase in human duodenal juice. These rises are also present in patients with complete obstruction of the common bile and pancreatic ducts, and since the pancreatic juice of man contains negligible amounts of alkaline phosphatase, it is clear that both hormones must cause small-intestinal alkaline phosphatase to be released into duodenal juice. The isoenzyme characteristics of bile, small-intestinal, and pancreatic alkaline phosphatase have been established, and isoenzyme studies used to confirm this new action of secretin and CCK-pancreozymin.

Topics: Alkaline Phosphatase; Amylases; Bilirubin; Cholecystokinin; Cholestasis; Electrophoresis, Polyacrylamide Gel; Glucosidases; Humans; Intestinal Mucosa; Intestine, Small; Isoenzymes; Lipase; Neuraminidase; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Secretin; Secretory Rate; Stimulation, Chemical

Topics: Amylases; Bicarbonates; Cholecystokinin; Humans; Lipase; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Stimulation, Chemical

Topics: Adolescent; Bile Acids and Salts; Celiac Disease; Child; Child, Preschool; Cholecystokinin; Clinical Enzyme Tests; Cystic Fibrosis; Duodenum; Female; Gallbladder; Humans; Infant; Male; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Stimulation, Chemical

Topics: Animals; Bethanechol Compounds; Cholecystokinin; Female; Glucagon; Humans; Pancreatic Cyst; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Propantheline; Radioisotopes; Radionuclide Imaging; Rats; Selenium; Stomach Ulcer; Vasopressins

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: Cholecystokinin; Clinical Enzyme Tests; Dietary Fats; Glucose Tolerance Test; Humans; Intestinal Absorption; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Secretin

Topics: Cholecystokinin; Cholelithiasis; Duodenum; Humans; Intestinal Secretions; Pancreas; Pancreatic Diseases; Secretin

Topics: Cholecystokinin; Diarrhea; Gastric Juice; Gastrins; Humans; Hyperplasia; Pancreatic Diseases; Peptides; Stomach

Topics: Adult; Animals; Cholecystokinin; Cross Reactions; Gastrointestinal Motility; Half-Life; Humans; Immune Sera; In Vitro Techniques; Iodine Radioisotopes; Methods; Milk; Pancreatic Diseases; Rabbits; Radioimmunoassay

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

Topics: Amylases; Cholecystokinin; Humans; Lipase; Pancreas; Pancreatic Diseases; Pancreatitis; Secretin

Topics: Child; Child, Preschool; Cholecystokinin; Female; Humans; Infant; Male; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Stimulation, Chemical

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

Topics: Amylases; Cholecystokinin; Duodenum; Glucose; Glycine max; Humans; Hydrogen-Ion Concentration; Lipase; Oils; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Trypsin

Topics: Alcoholism; Animals; Bicarbonates; Calculi; Cholecystokinin; Depression, Chemical; Dogs; Drug Synergism; Ethanol; Humans; Pancreas; Pancreatic Diseases; Pancreatic Fistula; Pancreatic Juice; Proteins; Secretin; Stimulation, Chemical

Topics: Cholecystokinin; Clinical Enzyme Tests; Humans; Methods; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Secretin

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: Adult; Aged; Bicarbonates; Bloodletting; Cholecystokinin; Duodenum; Female; Hemochromatosis; Humans; Intubation, Gastrointestinal; Lipase; Liver Cirrhosis; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatitis; Radiography; Secretin; Secretory Rate

Topics: Amylases; Cholecystokinin; Humans; Pancreatic Diseases; Secretin

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

Topics: Cholecystokinin; False Positive Reactions; Humans; Methionine; Pancreatic Diseases; Radioisotopes; Radionuclide Imaging; Selenium

Topics: Cholecystokinin; Computers; Dietary Proteins; False Positive Reactions; Online Systems; Pancreatic Diseases; Radioisotopes; Radionuclide Imaging; Selenium

Topics: Cholecystokinin; Duodenum; Humans; Intestinal Secretions; Lipase; Pancreas; Pancreatic Diseases; Pancreatic Juice; Trypsin

Topics: Amylases; Bicarbonates; Cholecystokinin; Humans; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Secretin

Topics: Adult; Aged; Alcoholism; Amylases; Bicarbonates; Cholecystokinin; Duodenum; Female; Humans; Intestinal Secretions; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin; Time Factors

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: Adult; Aged; Angiography; Biliary Tract Diseases; Blood Flow Velocity; Celiac Artery; Cholecystokinin; Contrast Media; Female; Gallbladder; Humans; Intestine, Small; Liver Circulation; Liver Diseases; Male; Mesenteric Arteries; Middle Aged; Oxygen Consumption; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Regional Blood Flow; Time Factors; Vascular Resistance

Topics: Cholecystokinin; Chymotrypsin; Duodenum; Humans; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin; Trypsin

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

Topics: Amylases; Cholecystokinin; Humans; Lipase; Methods; Pancreatic Diseases; Pancreatitis; Secretin

Topics: Cholecystokinin; Diagnosis, Differential; Duodenum; Humans; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatic Neoplasms; Pancreatitis; Radiography; Radionuclide Imaging; Secretin; Selenium

Topics: Atrophy; Bile Acids and Salts; Cholecystokinin; Duodenum; Endopeptidases; Humans; Intestinal Secretions; Pancreatic Diseases; Secretin; Stimulation, Chemical; Trypsin

Topics: Adult; Aged; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Juice; Peptides

Topics: Adult; Aged; Bicarbonates; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Male; Methods; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Secretin

Topics: Cholecystokinin; Duodenum; Humans; Intubation, Gastrointestinal; Methionine; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Selenium; Time Factors

Topics: Adolescent; Adult; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Secretin

Topics: Bicarbonates; Cholecystokinin; Diagnosis, Differential; Humans; Hydrogen-Ion Concentration; Intubation; Pancreas; Pancreatic Diseases; Secretin; Water-Electrolyte Balance

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: Adult; Aged; Calculi; Cholecystokinin; Diabetes Complications; Diabetes Mellitus; Female; Glucose Tolerance Test; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Neoplasms; Time Factors

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: Administration, Oral; Bicarbonates; Blood Glucose; Cholecystokinin; Fatty Acids, Nonesterified; Glucose; Glycerol; Humans; Injections, Intravenous; Insulin; Insulin Secretion; Intestinal Secretions; Pancreatic Diseases; Secretin

Topics: Cholecystokinin; Chymotrypsin; Duodenum; Humans; Methods; Pancreatic Diseases; Secretin; Trypsin

Topics: Acute Disease; Adult; Amylases; Cholecystokinin; Cholesterol; Chylomicrons; Chymotrypsin; Exocrine Glands; Female; Humans; Hyperlipidemias; Lipoproteins; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatitis; Secretin; Triglycerides

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

Topics: Adult; Bicarbonates; Cholecystokinin; Endopeptidases; Female; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin

Topics: Bethanechol Compounds; Catheterization; Cholecystokinin; Contrast Media; Humans; Injections, Intravenous; Male; Manometry; Middle Aged; Morphine; Nitroglycerin; Pain; Pancreatic Diseases; Pancreatic Ducts; Pancreatic Fistula; Pancreatitis; Pressure; Radiography

Topics: Animals; Ascites; Cholecystokinin; Dogs; Drainage; Humans; Lymph; Lymphatic Diseases; Pancreatic Diseases; Pancreatitis; Secretin; Serotonin; Thoracic Duct; Time Factors

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

Topics: Bicarbonates; Cholecystokinin; Duodenum; Humans; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin; Secretory Rate; Stimulation, Chemical

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; Humans; Methods; Pancreatic Diseases; Pancreatic Juice; Secretin; Secretory Rate; Stimulation, Chemical

Topics: Cholecystokinin; Pancreatic Diseases; Secretin

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: Angiography; Animals; Cholecystokinin; Dogs; Injections, Intra-Arterial; Injections, Intravenous; Liver; Methionine; Methods; Pancreas; Pancreatic Diseases; Radionuclide Imaging; Secretin; Selenium; Tomography

Topics: Adult; Bicarbonates; Bile Pigments; Chlorides; Cholecystokinin; Duodenal Ulcer; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin; Trypsin

Topics: Cholecystokinin; Humans; Insulin; Pancreas; Pancreatic Diseases; Secretin

Topics: Adult; Aged; Biliary Tract Diseases; Cholecystokinin; Female; Humans; Intubation, Gastrointestinal; Male; Methods; Middle Aged; Pancreatic Diseases; Pancreatic Extracts

Topics: Cholecystokinin; Female; Gastrectomy; Gastric Acidity Determination; Humans; Male; Methods; Pancreatic Diseases; Pancreatic Juice; Postoperative Complications; Secretin

Topics: Adolescent; Amylases; Carboxypeptidases; Child; Child, Preschool; Cholecystokinin; Cystic Fibrosis; Duodenum; Electrophoresis; Humans; Immunodiffusion; Immunoelectrophoresis; Infant; Methods; Pancreas; Pancreatic Diseases; Proteins; Secretin; Trypsin

Topics: Amylases; Cholecystokinin; Chymotrypsin; Feces; Humans; Pancreatic Diseases; Secretin; Trypsin

Topics: Adult; Bicarbonates; Cholecystokinin; Humans; Infusions, Parenteral; Injections, Intravenous; Lipase; Pancreas; Pancreatic Diseases; Pancreatic Juice; Pancreatitis; Secretin; Stimulation, Chemical

Topics: Adolescent; Age Factors; Amylases; Bicarbonates; Body Weight; Child; Child, Preschool; Cholecystokinin; Cystic Fibrosis; Duodenum; Exocrine Glands; Humans; Infant; Intubation, Gastrointestinal; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin; Water

Topics: Cholecystokinin; Humans; Injections, Intramuscular; Pancreas; Pancreatic Diseases; Pancreatic Juice; Parasympatholytics; Propantheline; Quaternary Ammonium Compounds; Secretin; Xanthenes

Topics: Cholecystokinin; Humans; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin

Topics: Biliary Tract Diseases; Cholecystokinin; Duodenum; Gastrointestinal Diseases; Humans; Liver Diseases; Pancreatic Diseases; Pancreatitis; Secretin

Topics: Biliary Tract Diseases; Cholangiography; Cholecystokinin; Gastrins; Humans; Intestine, Small; Pancreatic Diseases; Secretin; Stomach Diseases

Topics: Adult; Calculi; Cholecystokinin; Diabetes Complications; Glucose Tolerance Test; Humans; Insulin; Male; Middle Aged; Pancreatic Diseases; Retropneumoperitoneum; Secretin

Topics: Amylases; Carboxypeptidases; Cholecystokinin; Chymotrypsin; Duodenum; Electrophoresis; Humans; Isoflurophate; Lipase; Pancreas; Pancreatic Diseases; Secretin; Trypsin

Topics: Cholecystokinin; Humans; Pancreatic Diseases; Pancreatic Juice; Secretin; Secretory Rate

Topics: Adult; Aged; Amylases; Bicarbonates; Cholecystokinin; Duodenum; Female; Humans; Lipase; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin; Trypsin

Topics: Amylases; Cholecystokinin; Duodenum; Humans; Intubation, Gastrointestinal; Lipase; Pancreatic Diseases; Secretin

Topics: Adolescent; Adult; Aged; Animals; Child; Cholecystokinin; Dogs; Female; Hemoglobinometry; Humans; In Vitro Techniques; Intestinal Absorption; Iron; Iron Isotopes; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Extracts; Rats

Topics: Cholecystokinin; Glucose Tolerance Test; Humans; Pancreas; Pancreatic Diseases; Secretin

Topics: Animals; Cholecystokinin; Cysteine; Enzyme Repression; Enzymes; Ethionine; Pancreas; Pancreatic Diseases; Rats; Secretin

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: Amylases; Animals; Bethanechol Compounds; Carbachol; Cholecystokinin; Clinical Enzyme Tests; Dogs; Humans; Lipase; Methacholine Compounds; Neostigmine; Pancreatic Diseases; Rats; Secretin

Topics: Cholecystokinin; Gastrointestinal Hormones; Humans; In Vitro Techniques; Pancreatic Diseases; Pancreatic Juice; Secretin

Topics: Cholecystokinin; Gastrointestinal Hormones; Humans; In Vitro Techniques; Pancreatic Diseases; Pancreatic Juice; Secretin

Topics: Biliary Tract Diseases; Cholecystokinin; Humans; Intestinal Secretions; Pancreatic Diseases; Secretin

Topics: Cholecystokinin; Gastrointestinal Hormones; Hepatitis; Liver Cirrhosis; Pancreatic Diseases; Secretin

Topics: Cholecystokinin; Clinical Enzyme Tests; Duodenum; Gastric Acidity Determination; Humans; Pancreatic Diseases; Secretin

Topics: Adult; Amylases; Animals; Cholecystokinin; Clinical Enzyme Tests; Dogs; Enzymes; Humans; In Vitro Techniques; Isoenzymes; Lipase; Male; Pancreatic Diseases

Topics: Amylases; Cholecystokinin; Clinical Laboratory Techniques; Disease; Gastrointestinal Hormones; Humans; Pancreas; Pancreatic Diseases; Secretin; Trypsin

Topics: Cholecystokinin; Humans; Pancreas; Pancreatic Diseases; Secretin

A series of 53 cases of chronic pancreatic disease is described and attention drawn to the frequency with which symptoms are persistent rather than intermittent. A plea is made for the use of the term ;progressive' rather than ;relapsing' in describing many of these cases. Alcohol was an unimportant factor in the aetiology. The possibility of achieving an accurate and early diagnosis using the serum secretin/pancreozymin test is emphasized. The frequent relief of symptoms and the prevention of progress of the disease by surgery, especially sphincterotomy, is recorded.

Topics: Aged; Amylases; Celiac Disease; Cholecystokinin; Clinical Enzyme Tests; Clinical Laboratory Techniques; Gastrointestinal Hormones; Humans; Pancreas; Pancreatic Diseases; Pancreatitis; Pancreatitis, Chronic; Prognosis; Secretin; Statistics as Topic; Surgical Procedures, Operative

Topics: Amylases; Animals; Chlorides; Cholecystokinin; Dogs; Electrolytes; Ethionine; Pancreas; Pancreatic Diseases; Pancreatic Juice; Potassium; Secretin; Sodium

Topics: Biliary Tract; Biliary Tract Diseases; Cholecystokinin; Disease; Gastrointestinal Hormones; Humans; Pancreas; Pancreatic Diseases

Topics: Cholecystokinin; Disease; Gallbladder Diseases; Gastrointestinal Hormones; Humans; Pancreas; Pancreatic Diseases; Secretin

A simple evocative test has been used to study pancreatic function. Serial estimations of amylase and lipase in blood serum are made at intervals up to six hours and again at 24 hours after injecting intravenously standard doses of secretin and pancreozymin. The results of 213 tests on a normal group, in pancreatic disease, in biliary and hepatic diseases have been analysed and compared with the results of duodenal intubation and an oral glucose tolerance test. A combined evocative test and oral glucose tolerance test provide evidence of pancreatic dysfunction in the majority of cases of cancer of the pancreas and chronic pancreatitis. The conditions of the test are described and the pathological lesions in which false positive evocative tests may be found are indicated. The simple evocative test provides the earliest biochemical evidence of pancreatic disease in some patients with cancer of the pancreas and chronic pancreatitis.

Topics: Amylases; Cholecystokinin; Clinical Enzyme Tests; Gastrointestinal Hormones; Glucose Tolerance Test; Humans; Lipase; Male; Pancreas; Pancreatic Diseases; Pancreatitis, Chronic; Secretin

Pancreozymin in man as in animals appears to act as a specific enzyme stimulant. The preparations of pancreozymin used in these experiments also contain cholecystokinin, which causes the gall bladder to contract, and a smooth muscle stimulant, possibly substance P. The duodenal contents obtained in response to a standard dose of secretin and pancreozymin have been collected quantitatively in man and the volume and amount of bicarbonate, amylase, trypsin, and lipase measured in order to study pancreatic function. The results of 105 tests undertaken on a normal group, in pancreatic and biliary disease, and in non-pancreatic steatorrhoea have been analysed. In localized pancreatic lesions and after recovery from acute pancreatitis, normal function is often retained. Mild functional impairment may be demonstrated only by a poor enzyme output in the post-pancreozymin fractions, while at a later stage bicarbonate output is affected and finally the volume of the duodenal contents is reduced. The secretin-pancreozymin test is most valuable, therefore, in the more chronic and advanced forms of pancreatic disease in which it gives a good assessment of residual pancreatic function. In diagnosis care must be taken in interpreting a functional test in terms of anatomical pathology. The test has proved useful not only in diagnosis but also as a guide to treatment and an index of prognosis.

Topics: Amylases; Bicarbonates; Biological Assay; Cholecystokinin; Gastrointestinal Hormones; Humans; Lipase; Male; Muscle, Smooth; Pancreas; Pancreatic Diseases; Pancreatitis; Prognosis; Secretin; Substance P; Trypsin

Topics: Cholecystokinin; Gastrointestinal Hormones; Humans; Pancreas; Pancreatic Diseases; Secretin