Long term results of pancreaticojejunostomy in chronic pancreatitis

Fifty-one consecutive pancreaticojejunostomies for pain in chronic pancreatitis performed during the years 1964 to 1983 have been reviewed. Mean observation time was 8.2 years. Information on alcohol consumption, pain intensity and clinical signs of pancreatic dysfunction was recorded at regular intervals. Operative mortality was nil. Analysis showed no difference between alcohol abusers and other patients with regard to calcification, ductal dilation or exocrine and endocrine insufficiency. Good to excellent pain relief was achieved in 65 per cent of abusers and 88 per cent of nonabusers and was stable for at least five years. Patients who are heavy and unremitting abusers did not get much pain relief as a result of the operation. Patency of the anastomosis does not seem to be crucial for pain relief after pancreaticojejunostomy.

Effects of pectin and wheat bran on intraluminal pancreatic enzyme activities and on fat absorption as examined with the triolein breath test in patients with pancreatic insufficiency

In totally pancreatectomized patients breath 14CO2 excretion after ingestion of 14C-labeled triolein was significantly increased by a granulated pancreatic enzyme preparation and was reduced when pectin was added to the enzyme supplement. In the same patients pectin reduced trypsin, lipase, and amylase activities of jejunal aspirates after a test meal supplemented with pancreatic enzyme substitution, which was shown to give good enzyme activities in the intestine. In patients with chronic pancreatitis, breath 14CO2 excretion was reduced by wheat bran, which also caused a reduction in lipase and amylase activities of duodenal aspirates after a test meal. The findings demonstrate the efficiency of treatment with a granulated pancreatic enzyme preparation in restoring intraluminal enzyme activities and fat absorption in patients with pancreatic insufficiency. They also show that pectin and wheat bran may induce fat malabsorption and inhibit digestive enzyme activities in vivo.

Effects of pectin on glycaemia and insulinaemia after starch loading in normal, alloxan diabetic, and pancreatic duct-occluded rats

In normal rats, and in rats with reduced intraluminal amylolytic activity, acute administration of low methoxyl pectin with soluble starch via an oro-gastric tube was found to delay starch digestion. In normal rats pectin slightly lowered plasma glucose levels after a starch load. In pancreatic duct-occluded rats, in which intestinal pancreatic digestive enzyme activities are markedly reduced, an increased insulin secretion and a reduced glucose response were seen after starch loading even without the addition of pectin, when compared to normal control rats. In these duct-occluded rats pectin was found to further reduce starch digestion, and markedly suppress plasma glucose levels after a starch load without changing plasma insulin levels. In moderately alloxan diabetic rats, in which intestinal amylase activity also was substantially reduced, pectin reduced the glucose response to starch to a similar extent (about 30%) as in duct-occluded rats without changing the impaired insulin response. The results suggest that pancreatic insufficiency accompanied by reduced intraluminal activities of pancreatic digestive enzyme activities may be associated with a decreased glucose and an increased insulin response to starch loading and that the ability of dietary fibre to reduce postprandial glycaemia may, inter alia, involve an inhibiting action by fibre on starch digestion, especially manifested in conditions of amylolytic insufficiency.

Effects of dietary fiber on pancreatic enzyme activities of ileostomy evacuates and on excretion of fat and nitrogen in the rat

Ileostomized rats were fed diets with different fiber content. The addition of 5% pectin to the diet caused an increase in the wet weight, fat content, amylase activity per gram, and lipase output of the ileostomy evacuates. Twenty percent wheat bran in the diet increased weight, fat and nitrogen content, and trypsin output of the evacuates. In normal rats pectin added to a meal containing 3H-labeled triolein increased the isotope activity of the feces, indicating an impaired fat absorption. In rats operated on with occlusion of the pancreatic ducts with a tissue glue, the fat absorption was, however, not significantly affected by pectin. The results of the study show that fiber can cause a change in the intestinal enzymatic milieu of ileostomized rats and can cause steatorrhea, which can be explained, at least partly, by malabsorption.

Influence of pancreatic duct ligation on endocrine and exocrine rat pancreas

A parallel investigation into endocrine and exocrine pancreatic function, after duct-ligation in the rat, was performed to study the effect of reduced intestinal trypsin levels on insulin secretion and glucose tolerance. Animals with only a slight exocrine insufficiency displayed a normal insulin secretion and a normal glucose tolerance 4 weeks after operation. At 4-5 month s these animals showed a slight increase in glucose-induced insulin release when compared with control rats. However, animals operated on with a more complete ligation of the pancreatic ducts, who showed a marked exocrine insufficiency accompanied by decreased levels of intestinal trypsin, displayed a markedly increased insulin secretory response to intravenous glucose and an increased glucose tolerance. The results lend further support to our previous suggestion that, in the rat, the levels of intestinal trypsin may influence insulin secretory processes via complex feed-back mechanisms which may involve cholecystokinin and/or other intestinal hormones.

Pain reduction by an oral pancreatic enzyme preparation in chronic pancreatitis

In a double-blind study on 19 patients with the diagnosis of chronic pancreatitis, the effects of treatment with a granulated pancreatic enzyme preparation (Pankreon) were compared with those of placebo administration. One week of treatment with each preparation was preceded by one week without any medication. The patients kept daily records of their symptoms, plotting the severity of pain on an analog scale. Weekly assessments of the mean pain level were also made by an examiner questioning the patients. Recordings of body weights and pancreas and liver laboratory tests were done weekly. Fifteen of 19 patients noted less pain during the week of treatment with pancreatic enzymes as compared to that of placebo treatment (P less than 0.05). The average reduction of pain, as calculated for all patients, was 30% as evaluated by both patients (P less than 0.01) and the examiner (P less than 0.05). No differences were found in other parameters examined. A possible explanation of the findings could be an effect on the intraductal pressure by intraluminal trypsin.

Influence of dietary fiber on exocrine pancreatic function in the rat

Dietary fiber inhibits pancreatic enzyme activity--i.e., trypsin, lipase and amylase--in buffer solutions and in human duodenal juice in vitro. It is well established that oral administration of trypsin inhibitor stimulates the secretion and growth of the rat pancreas. In the present study, trypsin inhibitor (Trasylol) as well as dietary fiber such as pectin of low (37%) methoxylic esterification and wheat bran were found to stimulate pancreatic enzyme secretion in acute experiments in conscious rats with bile-pancreatic fistulae. Feeding for 10 days with wheat bran resulted in increased pancreatic weight and in increased protein and trypsinogen content. Administration of pectin of high (73%) methylic esterification caused increased pancreatic protein content and that of low methylic esterification increased pancreatic trypsinogen activity/milligram tissue. The results suggest that pectin and wheat bran may interfere with the feedback regulation of pancreatic enzyme secretion exerted by intraluminal trypsin, and, like trypsin inhibitor, have a secretagogue and trophic effect on the pancreas.

Effects on the exocrine and endocrine pancreas of duct occlusion with two different tissue glues in the rat

Exocrine and endocrine pancreatic function was studied in the rat after occlusion of the pancreatic ducts with acrylate or prolamine, respectively. After 5 months the effect of these procedures was a clear-cut exocrine insufficiency as evidenced by reduced enzyme activities in pancreatic tissue and in intestinal content, while the endocrine function was not impaired. The insulin secretory response to an intravenous glucose load was rather increased in duct-occluded rats, and the glucose tolerance was improved. The liver glycogen levels in duct occluded rats were decreased. As judged from the present investigation there was no striking difference between the effects of acrylate and prolamine on either exocrine or endocrine pancreas. The results suggest that long-term duct occlusion in the rat by acrylate or prolamine is harmless to the endocrine pancreas. The improvement of the glucose-induced insulin response and the glucose tolerance is probably due to an enteropancreatic feedback mechanism elicited by low levels of intestinal trypsin.

Effect of dietary fiber on pancreatic enzyme activity in vitro

The importance of various factors for dietary fiber effects on pancreatic enzyme activities was studied in vitro. Pectin of high methylic esterification and guar gum, which reduced enzyme activities, particularly lipase activity, increased the viscosity of duodenal juice. Increasing duodenal juice viscosity by polyethlene glycol also caused a reduction particularly of lipase activity. Pectin of low methylic esterification, which reduced especially amylase and lipase activities, significantly lowered duodenal juice pH. Lowering duodenal juice pH by hydrochloric acid caused a reduction especially of amylase and lipase activities. Pretreating fiber at acid pH tended to increase its enzyme-inhibiting properties. Trypsin adsorption to wheat bran was partly reversible by buffer washings. Changing ionic strength and incubation time appeared relatively unimportant for the effects of the fiber on enzymes. It is assumed that the inhibitory effects of the fiber on enzymes are attributed inter alia to effects on viscosity, pH, and adsorption, and further that gastric acidification of fiber and conditions lowering intestinal pH may enhance these effects.

In vitro inhibition of pancreatic enzyme activities by dietary fiber

Trypsin, amylase, lipase and phospholipase activities were assayed in buffer solutions and in human duodenal juice after incubation with different types of dietary fiber. In buffer solutions, trypsin activity was slightly reduced and amylase activity heavily reduced by pectin of low methylic esterification (LM pectin). Lipase activity was markedly reduced by LM pectin and also moderately reduced by pectin of high methylic esterification (HM pectin). Phospholipase was hardly influenced at all by fiber. Activities of pancreatic enzymes in human duodenal juice were examined after in vitro incubation with pectins, guar gum, wheat bran and ispaghula. Ispaghula did not affect the enzymes except for lipase activity, which was moderately inhibited. The other fiber preparations examined reduced amylase activity by 35-100% at fiber concentrations of up to 1.5 g%, lipase by 40-95% and trypsin by 40-85%. LM pectin had the strongest inhibitory effect among the different fiber preparations studied. Phospholipase activity was only influenced by the pectins, which caused a 75% reduction. It is concluded that dietary fiber of different kinds has the capacity to inhibit pancreatic enzyme activities. This inhibitory effect is dependent on the type of fiber and differently affects the different enzymes. Further, the inhibition seems to be more pronounced when exerted in human duodenal juice than in conventional buffer systems.