The effect of jejunal nutrition on pancreatic exocrine function

Pancreatic juice was continuously diverted from the Wirsungial duct by nasopancreatic drainage of the remnant of the gland after pylorus preserving partial pancreato-duodenectomy in 14 patients. On the 7th postoperative day with stabilized pancreatic secretion the juice was collected in 10 min fractions, while interdigestive secretory phases of the parenchyma were established by volume changes. At the beginning of a phase, 100 ml slightly hyperosmolar (400 mOsm/l) oligopeptide diet with 360 kJ (90) kCal) was given as a bolus injection to another 7 patients or 60 min infusion into the second jejunal loop by fine-needle catheter jejunostomy to another 7 patients. Pancreatic water, bicarbonate, protein, chymotrypsin, peak amylase levels, and integrated secretory responses were measured. It was observed that infusion of the diet did not disturb cycling interdigestive phases and did not increase peak and integrated outputs. Bolus administration interrupted interdigestive phases and stimulated pancreatic water, bicarbonate, protein, chymotrypsin and amylase outputs nonparallelly. On the basis of the data it was concluded that pancreatic secretion seems to be well preserved without duodenal regulatory mechanisms, and continuous jejunal infusion feeding seems to be useful in pancreatic disease and in other postoperative states when pancreas has to be put into rest.

The effect of early postoperative nutrition on exocrine pancreatic function

Subsequent to pancreato-duodenectomy with preservation of the pylorus in 12 patients the effect of parenteral and enteral nutrition on pancreatic secretion were compared. The pancreatic juice was continuously diverted from the Wirsung duct by nasopancreatic drainage. Postoperative feeding was administered by fine-needle catheter jejunostomy in 7 patients and 5 patients received total parenteral nutrition. The pancreatic juice was collected in four-hour fractions and it was analysed for volume, bicarbonate, protein, chymotrypsin and amylase. It has been found that on the first two days after the operation there was a slow increase in the measured values and on the third postoperative day after an abrupt rise the pancreatic secretion became steady. No differences in exocrine pancreatic secretion were observed between the enteral and parenteral methods of feeding. According to these data the two methods seem to be of the same value in the postoperative therapy.

[The effect of two different methods of jejunal feeding on pancreatic function]

Pancreatic juice was continuously diverted from the Wirsungial duct by nasopancreatic drainage of the remnant of the gland after pylorus preserving partial pancreato-duodenectomy in 14 patients. On the 7th postoperative day with stabilized pancreatic secretion the juice was collected in 10 min fractions, while interdigestive secretory phases of the parenchyma were established by volume changes. At the beginning of a phase 100 ml slightly hyperosmolar (400 mosmol/L) oligopeptide diet with 90 kcal was given as a bolus injection for 7 patients or 60 min infusion into the second jejunal loop by fine needle catheter jejunostomy for 7 patients also. Pancreatic water, bicarbonate, protein, chymotrypsin, amylase levels peak, and integrated secretory responses were measured. It was observed, that infusion of the diet did not disturb cycling interdigestive phases and did not increase peak and integrated outputs. Bolus administration interrupted interdigestive phases and stimulated pancreatic water, bicarbonate, protein, chymotrypsin and amylase outputs nonparallelly. On the basis of their data authors concluded, that pancreatic secretion seems to be well preserved without duodenalregulatory mechanisms; and continuous jejunal infusion feeding seems to be useful in pancreatic disease and in other postoperative states when pancreas has to be put into rest.

Perspectives of CCK antagonists in pancreatic research. Part II. Experimental studies

In this article, the effects of different classes of cholecystokinin (CCK) receptor antagonists in CCK-related physiological processes of the pancreas have been discussed. Both glutaramic acid derivatives and natural (benzodiazepine) analogs are potent, competitive antagonists of peripheral CCK receptors. These compounds thus provide a powerful tool for investigating the physiological and pharmacological actions of CCK in the gastrointestinal system, and have already clarified the role of CCK in pancreatic secretion and trophism or growth.

Essential role of cholecystokinin in pancreatic regeneration after 60% distal resection in rats

The essential role of cholecystokinin (CCK) in pancreatic regeneration after pancreatitis or resection has been supposed, but not yet clearly demonstrated. In rats, 6-8 weeks after 60% distal resection of the pancreas a gradual increase in pancreatic weight and contents of DNA, protein, trypsin, chymotrypsin and amylase, occurred (there was no increase in lipase); Pancreatic regeneration stopped thereafter. Nonparallel increases in enzyme values were similar to those seen after CCK administration. Indeed, basal CCK levels increased significantly by the 6th week and declined thereafter. A one month s.c. administration of CCK-octapeptide (CCK-8) (3 x 300 ng/kg/d) accelerated regeneration in the first month, but it had almost no effect during the second or third postoperative months. A two week s.c. administration of a specific CCK antagonist, CR 1409 (3 x 4 mg/kg/d) totally prevented regeneration by the fifth and sixth weeks, but did not diminish pancreatic weight or DNA and protein contents during the first two weeks. Alcohol administration (12 g/kg/d) reduced CCK release and prevented pancreatic regeneration during the three-month experimental period. These data indicate that CCK has an essential role in pancreatic regeneration and that the deleterious effect of alcohol on regeneration involves inhibition of CCK release.

Effect of enteral nutrition on exocrine pancreatic function

Twelve patients with chronic pancreatitis underwent a pancreatoduodenectomy in which the pylorus was preserved. The effects of parenteral and enteral nutrition on pancreatic secretion were compared. Postoperative nutrition was administered by needle-catheter jejunostomy in seven patients and by total parenteral nutrition in five patients. Pancreatic juice, drained directly from the pancreatic duct, was collected in 4-hour fractions. Volume, bicarbonate, protein, amylase, and chymotrypsin were measured. In the first two postoperative days, there was a slow increase in all measured indices. On the third postoperative day, an abrupt rise occurred, after which pancreatic secretion stabilized. No differences in exocrine pancreatic secretion were observed between the enteral and parenteral methods of feeding.

The effect of long-term administration of lorglumide (CR 1409) on rat pancreatic growth and enzyme composition

The effects of lorglumide (CR 1409), a potent cholecystokinin (CCK) receptor blocker developed recently by the Rotta Research Laboratories, were studied on pancreatic growth and enzyme composition. In secretory studies, the inhibitory effect of 4 mg/kg of lorglumide administered subcutaneously proved to last more than 3 h. The trophic effect of exogenous CCK (600 ng/kg given three times daily for 2 weeks) was significantly decreased by the simultaneous administration of 4 mg/kg of lorglumide. To study the role of endogenous CCK released by feeding while maintaining pancreatic trophism, 4 mg/kg of lorglumide was administered subcutaneously four times daily during the feeding period for 2 weeks. Lorglumide significantly decreased pancreatic weight, pancreatic content of soluble protein, trypsinogen, and chymotrypsinogen, while decreases in DNA, lipase, and amylase failed to reach statistical significance. According to our experiments, high-doses of lorglumide could inhibit not only the trophic effect of exogenous CCK but also the effect of endogenous CCK released by food and lorglumide itself.

[The effect of early postoperative jejunal feeding on the exocrine function of the pancreas]

Subsequent to pancreatoduodenectomia with pylorus retention on 12 patients suffering from chronic pancreatitis we analysed the effect of artificial nutrition on pancreas-secretion by examining the pancreatic juice extracted directly from the Wirsung duct. We used post-operative nutrition administered by fine-needle catheter jejunostomy in 7 patients and 5 patients received postoperative support by total parenteral nutrition as a control-group. We analysed the pancreatic juice collected in four hour fractions for volume, direct protein, amylase, chymotrypsin, bicarbonate. It has been found that on the first two days after the operation we can see a slow increase in the measured values and on the third postoperative day after an abrupt rise the pancreas secretion became steady. Between the two methods of artificial nutrition applied it was impossible to prove an observable difference concerning their effect on the pancreas. According to our observations the two methods are equivalent in the postoperative therapy of patients operated on because of chronic pancreatitis.

[Gastrinoma and carcinoma-carcinoid tumor causing Zollinger-Ellison syndrome]

7 gastrinomes and 1 gastrin-producer complex carcinoma-carcinoid tumor were examined by light and electron microscopical-method and by immunohistochemical method. In six cases, the tumor was in the pancreas or in the wall of duodenum; in two cases its localisation was of extra-gastroenteropancreatic (liver, lymph node). All patients developed Zollinger-Ellison syndrome, three patients bled and one had diarrhea. One patient had other tumors, besides gastrinome, which were characteristic of MEN-I syndrome. By immunohistochemical methods all tumors proved to be gastrin and neuron-specific-enolase positive. In four cases somatostatin positivity, in some cases glucagon, pancreatic polypeptide, S-100 protein, keratin and carcinoembryonal antigen positivity were detected. Relation could not be detected between other polypeptide hormones, produced besides gastrin, and biological behaviour of tumor and clinical symptoms.

[Requirements for successful pancreatic enzyme replacement therapy (comparative study of Kreon and Panpur)]

Factors influencing the effectivity of replacement therapy with Panpur and Creon were controlled by in vivo and in vitro investigations. Both enteric coated preparations were equally acid protected, they even seemed to be more effective in hyperacid than in anacid chronic pancreatitis patients. Thus the uneven results of Panpur treatment in pancreatic steatorrhea cannot be explained by acid inactivation of the enzymes. Creon dose-dependently ameliorated the steatorrhea as well as vitamin B12 absorption while crushed but not the intact Panpur has only some insignificant effect. Good mixing of pancreatin with the B12-intrinsic factor - R protein complex and with the protein containing meal seems to be important for digestion of protein as well as fat. Unbound, overflowing trypsin activity of Panpur resulted in fast proteolytic inactivation of lipase. This could be diminished by soybean trypsin inhibitor which increased the in vivo effectiveness of the preparate. In summary Creon fulfilled two important factors of replacement therapy more successfully than Panpur: good mixing with meals and stability of lipase against proteolytic splitting, that is why it proved to be more effective for replacement therapy of pancreatic insufficiency.

The effect of CR 1409, a potent CCK receptor antagonist, on basal and stimulated pancreatic secretion in rat

The effect of a specific cholecystokinin (CCK) receptor blocker from Rotta Research Laboratorium (Monza/Milano, Italy), CR 1409 (Lorglumide), on pancreatic secretion was investigated. CR 1409 caused a rightward and parallel shift in the dose-response curve of CCK-8-stimulated pancreatic protein secretion in anesthetized rats, demonstrating a competitive mechanism of inhibition. The mean pA2 value, showing the 50% inhibitory dose of CR 1409, was 6.4. CR 1409 proved to be about 1,000 times more potent as a CCK receptor blocker than proglumide, the first glutaramic acid analogue with anti-CCK potential. In conscious rats, pancreatic protein and water secretion were significantly diminished for about 2 h in response to 300 micrograms/kg of CR 1409 given subcutaneously during diversion of pancreatic juice, demonstrating inhibition of endogenous CCK by this new glutaramic acid derivative. By contrast, during reintroduction of precollected pancreatic juice into the duodenum, when the release of CCK is almost totally eliminated, pancreatic secretion was not modified by the same dose.

Course and regression of acute interstitial pancreatitis induced in rats by repeated serial subcutaneous cholecystokinin-octapeptide injections

The aim of this study was to examine histologic and biochemical alterations in experimental acute interstitial pancreatitis (AIP) induced by serial repeated supramaximal cholecystokinin-octapeptide (CCK-OP) stimulation in rats. High doses of CCK-OP (60 micrograms/kg body wt) were administered subcutaneously (sc) six times at hourly intervals for 1 d (Group I) or for 3, 5, or 7 d (Group II). Rats were killed after 1, 3, 5, 7, and 10 d in both groups and also after 13, 20, and 27 d in Group II. During the course of the AIP, the morphological alterations were more pronounced in the repeatedly treated rats, but their appearance and disappearance essentially occurred in parallel in the two groups. Increased mitotic activity of the centroacinar and acinar cells were observed in d 5 and rose further even in Group II. The pancreatic weight and the protein and DNA contents reached a minimum on d 5 in both groups. The lowest enzyme activities did not occur in parallel. Thereafter, functional regeneration occurred despite continuing CCK-OP overstimulation in Group II. The toxicity of repeated CCK-OP hyperstimulation, thus, was limited: after its fifth administration, it failed to further aggravate the acute pancreatic damage or prevent the regeneration. This might be explained by a decreased CCK-OP sensitivity of the preexisting acinar cells, and/or increased CCK-OP tolerance of newly-formed ones.

Isoprenaline and the pancreas in dogs

1. In conscious dogs basal pancreatic secretion per 100 min was significantly reduced by 0.75 microgram kg-1h-1 of isoprenaline. The expected spontaneous peaking was seen only after stopping the drug. 2. Following propranolol, the 100-min pancreatic secretion was less than control but greater than secretion after isoprenaline. The interpeak interval was increased, and the perigee levels (interpeak) were higher than in the controls. Peak protein secretion was unaltered but volume was reduced. 3. Guanethidine did not abolish periodicity but it prolonged the interpeak interval. Protein peaks and 100-min totals were lower than control and volume perigees higher. 4. It is concluded that beta-adrenoreceptor stimulation inhibits pancreatic secretion. Adrenergic antagonists exert similar inhibitory effects indicating a complex role for the sympathetic nervous system in the control of pancreatic secretion.

[Alcoholic pancreatitis]

The authors describe the different pathomechanisms playing a role in the development of alcoholic pancreatitis, its forms, histological characteristics and clinical course. The attention is drawn also to certain diagnostic difficulties. Of the complications associated with chronic pancreatitis diabetes mellitus is dealt with detailed.

Mechanisms of action of alcohol administration on the trophic effect of soybean trypsin inhibitor and cholecystokinin octapeptide in rat

Influence of alcohol administration on the trophic effect of cholecystokinin-octapeptide and soybean trypsin inhibitor administration was examined in male Wistar rats. Two x 4 mL of 20% alcohol given intragastrically during 2 wk did not significantly influence pancreatic weight, DNA, protein, trypsin, chymotrypsin, amylase, lipase, or trypsin inhibitor contents of the pancreas. It diminished the hypertrophy but not the hyperplasia seen after CCK-8 treatment, and eliminated the hyperplasia, as well as the hypertrophy provoked by SBTI administration. Secretory studies and CCK measurements demonstrated decreased CCK release in response to SBTI stimulation after 3-d alcohol administration. The results indicate that alcohol inhibits the enzyme synthesis of the CCK stimulated dividing and/or newly formed acinar cells and the endogenous CCK release.

Time-course of changes in pancreatic size and enzyme composition in rats during starvation

The effect of starvation for 3, 5, or 7 d on body weight, fat stores, pancreatic weight, and enzyme composition was studied in 300 g rats and was compared with a 3-d fast in 200 g rats. In the 300 g animals, fasting led to a gradual hypotrophy of the pancreas with a marked, continuous decrease in amylase content. Pancreatic lipase, trypsinogen, chymotrypsinogen, proelastase, and secretory trypsin inhibitor contents increased temporarily, but by d 7, they declined to about the initial values. This decline in enzyme levels coincided with the exhaustion of fat stores. The decrease in amylase content could be related to decreases in circulating insulin levels, whereas the temporary increase in lipase content may be owing to changes in plasma free fatty acid concentrations. In 200 g rats, starvation for 3 d led to exhaustion of fat stores that was accompanied by greater losses of pancreatic weight, protein, and amylase contents. In addition, the levels of trypsinogen and chymotrypsinogen decreased and lipase was unchanged. These findings indicate that during starvation, changes in pancreatic secretory enzymes are time-dependent and vary with the age, body weight, and/or adipose tissue mass of the rats.

Prostaglandin F2 alpha and prostacyclin tissue levels in early phases of trypsin-induced acute pancreatitis in rats

Local variations of prostaglandin (PG) I2 and F2 alpha were studied in the pancreatic tissue during the first hour of an acute experimental necrohemorrhagic pancreatitis. The local pancreatitis was induced by trypsin injection into the interstitium of the splenic part of rat pancreas, and a saline injection was given into the interstitium in the duodenal part of the same pancreas as control. PGF2 alpha level was measured by specific radioimmunoassay (RIA), and the stable degradation product of PGI2, the 6-keto-PGF1 alpha, was determined also by RIA as an index of PGI2 level. The results were compared between the two regions and with control intact pancreata. The PGI2 level transiently decreased, whereas the PGF2 alpha increased in the region of localized hemorrhagic pancreatitis when compared with the intact pancreata. By contrast, the quickly disappearing edematous reaction induced by saline injection was accompanied by opposite changes in the two PGs studied: PGI2 was transiently elevated and PGF2 alpha diminished. In consequence, the ratio of the two PGs was shifted in favor of PGI2 in a transient edematous reaction and in favor of PGF2 alpha in hemorrhagic pancreatitis. It was concluded that PGI2 plays some protective role while PGF2 alpha might be one of the aggressive mediators in the inflammatory process. Their biological importance must be limited since PGF2 alpha alone did not induce pancreatitis nor did PGI2 protect against the trypsin-induced local pancreatitis.

Alcohol-induced chronic pancreatitis in rats after temporary occlusion of biliopancreatic ducts with Ethibloc

Chronic obstructive pancreatitis-like histological and biochemical alterations were provoked in male Wistar rats with Ethibloc occlusion of the common bile duct and the main pancreatic ducts. After the disappearance of the glue from the ducts, a gradual and almost total recovery was demonstrated during a 2-month observation period. About 12 g/kg of alcohol (20% vol/vol) given daily by gastric intubation and ad libitum intake inhibited the recovery of pancreatic weight and enzyme contents in the occluded rats, and within a 2-month period chronic calcifying-type pancreatitis became evident with some signs of remaining obstructive pancreatitis-like lesions. Cessation of alcohol administration after 2 months resulted in a recovery of pancreatic weight and enzyme contents, although morphological regeneration was less pronounced and calcification remained visible in some rats. A 50% raw soy flour diet provoked some further changes in the proportion of enzymes without any supplementary increases of pancreatic weight and protein content. This animal model of chronic pancreatitis demonstrates that chronic obstructive and calcifying pancreatitis can appear together and earlier if the etiological factors act in combination. Suppression of pancreatic regeneration by alcohol seems to be necessary to maintain chronic pancreatitis-like lesions and to develop calcification.

A comparative study of gastric secretory stimulants in conscious dogs

1. In conscious dogs with gastric fistulae, Heidenhain pouches and Thomas duodenal fistulae, pentagastrin was found to be a more potent peak acid and pepsin stimulant in both innervated stomach and vagally denervated pouch than methacholine chloride. 2. Slopes of curves relating response to the logs of molar doses of pentagastrin and methacholine, at peak secretion, did not differ significantly. The maximal pentagastrin stimulated secretion from the pouch was smaller than that for methacholine; from the fistula they did not differ. 3. Ganglionic blockade depressed methacholine stimulated peak acid secretion, but did not affect pentagastrin stimulated acid secretion. Dose-response curves for methacholine-induced acid and pepsin secretion at the perigee did not differ from those obtained with ganglionic blockade. 4. Ganglionic blockade depressed pepsin secretion from the fistula whether stimulated with pentagastrin or methacholine. Pouch pepsin secretion was small and no difference between curves was seen.

[Morphologic and biochemical changes in acute experimental interstitial pancreatitis]

Repeated subcutaneous injections of cholecystokinin-octapeptide has brought about an acute interstitial pancreatitis in rats. The aim of the experiment was the study of histological and biochemical alterations with special regard to regeneration phenomena. The treatment was carried out for 1 (group 1), 3,5 and 7 (group 2) days. Morphological alterations were more pronounced in group 2 than in group 1, but the pathological process was principally similar in both groups. Lowest values of pancreatic weight, protein and DNA content were attained in both groups at day 5. After this, protein and DNA started to increase. Hyperstimulation with CCK-OP on day 5 did not increase the degree of pancreas damage, nor did it prevent morphological and functional regeneration. The reason of this may be the decreased CCK-OP sensitivity of pancreatic acinar cells and/or the increased CCK-OP tolerance of newly formed acinar cells.

Action of amino acids on stomach, pancreas, and gallbladder in dogs

An intravenous infusion of a 3% solution of amino acids was given to 8 dogs, all with Heidenhain pouches and gastric fistulae. Four of these had duodenal cannulae opposite the pancreatic and 4 opposite the biliary ampulla. The usual basal 100 min spontaneous peaking of pancreatic juice volume and protein secretion was seen but peaks were abolished by the amino acid infusion and troughs were slightly elevated, but the total 90 min volume protein and bicarbonate outputs were not different from control. Gastric acid and pepsin secretions were augmented reaching a peak during the first hour with a subsequent decline. The 90 min acid and pepsin output was significantly higher than control. The gallbladder contracted during the first hour and remained thus until the infusion was terminated. This happened even when the duodenum was kept alkaline, but was abolished by ganglionic blockade. During intravenous amino acid infusion the patterns of gallbladder activity and pancreatic secretion resembled those of the post cibal rather than fasting state.

Endocrine pancreas in chronic pancreatitis. A qualitative and quantitative study

This study includes nine patients with diabetes mellitus (DM) and chronic pancreatitis (CP) (group I); 11 patients without DM and with CP (group II); and a control group (group III) consisting of five autopsy cases with neither DM nor CP. These groups were evaluated by routine histologic stains and immunocytochemical stains for insulin, glucagon, and somatostatin. Semiquantitative assessment of the degree of exocrine pancreatic atrophy and of two endocrine features (diffuse endocrine proliferation and ductoendocrine proliferation) was performed for each pancreas. Quantitative determination of the cell composition was carried out in three kinds of islets (parenchymal, sclerosis, and newly formed). The mean percentages of the insulin-producing B cells were significantly lower in the parenchymal (44.5%) and new (34.3%) islets of diabetic patients than in the controls (67.8%) and parenchymal (59.4%) islets of nondiabetic patients. The mean percentages of glucagon-producing A cells revealed significant increases in the parenchymal (43.0%) and new (55.7%) islets of diabetic patients as compared with the controls (24.3%) and parenchymal (32.2%) islets of nondiabetic patients. The mean percentage of somatostatin-producing D cells was significantly increased in the parenchymal islets (12.4%) of diabetic patients as compared with the parenchymal islets (8.2%) of nondiabetic patients and controls (7.5%). These findings correlate with clinical data of frequent DM in CP, but are partly in contrast with previous immunohistochemical analysis findings in CP.

A case of primary sclerosing cholangitis mimicking chronic pancreatitis

A case of a 37 year old male is presented, who died from primary sclerosing cholangitis (PSC) with characteristic radiological picture and laboratory data suggesting chronic pancreatitis (CP).