Somatostatin versus secretin in the treatment of actively bleeding gastric erosions

In a double-blind, prospective, randomized trial, 63 patients with actively bleeding gastric erosions were treated with somatostatin (31 patients) or secretin (32 patients). Both drugs were administered by intravenous infusions for 48 or 72 h. The active bleeding and the effect of the therapy was endoscopically established. Somatostatin had a significantly (p < 0.05) better effect on the control of bleeding (29 vs. 23 patients), transfusion requirements (5.8 vs. 7.4 units, p < 0.01) and on the need of surgery (1 vs. 6 patients, p < 0.01). The mortality and the rebleeding rate did not differ between the two groups. The results show that somatostatin is more effective than secretin in the control of active bleeding form gastric erosions.

Effect of continuous intravenous infusion of secretin preparation (secrepan) in patients with hemorrhage from chronic peptic ulcer and acute gastric mucosal lesion (AGML)

The purpose of the present study was to investigate the hemostatic effect of continuous intravenous infusion of secrepan (secretin preparation, Eisai Company Ltd. Tokyo) on gastroduodenal hemorrhage in patients with chronic peptic ulcer and AGML (acute gastric mucosal lesion). The patients consisted of 37 cases of bleeding ulcer (13 cases of chronic peptic ulcer and 24 cases of AGML). Secrepan was infused at a rate of 2 U/kg/hr for the first 3 days and 0.5 U/kg/hr for the next 4 days. The cumulative hemostatic rate in the chronic peptic ulcer group was 53.9% after 36 hours, and 76.9% after 48 hours of infusion, but no significant change in rate was observed thereafter. The cumulative hemostatic rate in the AGML group was 52.2% after 36 hours, and 95.7% after 72 hours of infusion. The hemostatic rate in chronic peptic ulcer and AGML cases with only slight or moderate bleeding was 100%, and no recurrent hemorrhaging was observed. The hemostatic rate in chronic peptic ulcer cases with severe bleeding was 62.5% and in AGML cases with severe bleeding was 93.3%, and 7 of 15 cases showed recurrent hemorrhage. Our findings indicated that continuous intravenous infusion of secrepan had more favorable effects on AGML cases, than on chronic peptic ulcer cases.

Failure of secretin to exert an ameliorative effect on acute reflux pancreatitis in the rat

This study was undertaken to evaluate the possible ameliorative effect of secretin on acute reflux pancreatitis in the rat. Thirty days after the performance of a gastrojejunal anstomosis, in all rats (36 Sprague-Dawley, mean weight 250 g) acute pancreatitis was induced by creating a closed duodenal loop for 12 h. In the subsequent 12 h group A (14 rats) received continuous intra-arterial infusion of secretin (5 CU/kg/h); group B (22 rats) received equal volumes of saline solution. Serum amylase and pancreatic histology were evaluated. In group B a mild form of pancreatitis was observed, since the mean values of haemorrhage, necrosis and steatonecrosis, indices of severe disease, were found to be low. Group A presented similar results. No difference was documented between the two groups for both the histological findings and serum amylase. We can conclude that despite the reported protective and ameliorative effects of secretin in cerulein-induced acute pancreatitis in the rat, our data do not support a similar action of secretin in the closed duodenal loop model.

[Secretin versus cimetidine in the therapy of active bleeding from peptic gastroduodenal lesions. A prospective, randomized, double-blind, multicentric study]

In a multicentric, prospective, double-blind, randomized trial 101 patients with active bleeding (Forrest, Type 1/b) from gastroduodenal ulcers or erosions were treated with secretin (n = 50, dose: 800 clinic units/24 hours) or cimetidine (n = 51, dose: 75 mg/hour). The bleeding and the effect of the therapy were endoscopically confirmed. The bleeding was stopped during 48 hours of treatment in 36 patients of the secretin treated group and in 25 of the cimetidine treated group (p less than 0.05). In 72 hours the control of bleeding was established in a total of 75 patients (41 secretin, 34 cimetidine; not significant). Surgery was necessary in 7 vs. 9 cases. The mortality was 1 vs. 4 cases. The mean transfusion requirements were 6.6 units in secretin- and 8.2 units in cimetidine treated group (p less than 0.01). There was no difference in rebleeding rate. The results show a trend in favour of secretin compared to cimetidine in the treatment of active bleeding from gastroduodenal ulcers or erosions.

A new therapeutic trial of secretin in the treatment of intrahepatic cholestasis

Many animal experiments have been studied on the choleretic effects of secretin. We intended to estimate secretin choleresis in human (15 patients) who had received PTCD or T-tube insertion into the common bile duct. Based upon these data of secretin and choleresis, secretin was administered to 11 patients with prolonged jaundice due to intrahepatic cholestasis in order to evaluate this as a new therapy for intrahepatic jaundice. As controls, eleven patients with intrahepatic cholestasis treated with steroid hormones and/or phenobarbital were used. In all cases with biliary drainage, secretin produced a remarkable choleretic effect with a high concentration of bicarbonate. In 9 out of 11 patients with intrahepatic cholestasis who were treated with secretin, levels of serum bilirubin decreased linearly and other liver function tests returned to the normal range. The mean values of T1/2 (number of days required for reduction by half) of serum bilirubin in 9 effective cases to secretin was 10.8 days. On the other hand, that in 11 effective cases treated with steroid hormones and/or phenobarbital was 23.2 days. These results suggest that secretin therapy may be an effective treatment for intrahepatic cholestasis.

Effect of continuous intravenous infusion of secretin preparation (secrepan) in patients with hemorrhage from chronic peptic ulcer and AGML

This study was conducted to evaluate the hemostatic effect of continuous intravenous infusion of secrepan (secretin preparation, Eisai Company Ltd. Tokyo) on gastroduodenal hemorrhage in patients with chronic peptic ulcer and AGML (acute gastric mucosal lesion). The patients consisted of 37 cases of bleeding ulcer (13 cases of chronic peptic ulcer and 24 cases of AGML). Secrepan was infused at a rate of 2U/kg/hr for the first 3 days and 0.5U/kg/hr for the next 4 days. The cumulative hemostatic rate in the chronic peptic ulcer group was 53.9% after 36 hours, and 76.9% after 48 hours of infusion, but no significant change in rate was observed thereafter. The cumulative hemostatic rate in the AGML group was 52.2% after 36 hours, and 95.7% after 72 hours of infusion. The hemostatic rate in chronic peptic ulcer and AGML cases with only slight or moderate bleeding was 100%, and no recurrent hemorrhaging was observed. The hemostatic rate in chronic peptic ulcer cases with severe bleeding was 62.5% and in AGML cases with severe bleeding was 93.3%, and 7 of 15 cases showed recurrent hemorrhage. Our findings indicated that continuous intravenous infusion of secrepan had more favorable effects on AGML cases, than on chronic peptic ulcer cases.

[Results of treatment of ulcer hemorrhages]

The results of 270 patients, admitted from 1978 to 1985 because of upper gastrointestinal bleeding from ulcers or erosions were analysed retrospectively. Chronic peptic ulcers were the most common bleeding sites (192 patients, 71%). 49 patients (18%) bled from acute lesions and 29 (11%) from drug-induced ulcers. 53% of all patients exhibited an oozing hemorrhage (type Forrest 1 b) during emergency endoscopy. Within the eight-year-period hospital mortality dropped from 18% to 8%. In parallel the prognosis of oozing bleeding improved. In this period the patients were more often treated with secretin or somatostatin. Hence the frequency of emergency operations for patients with oozing bleeding could be reduced from 44% in 1978 to 10% in 1985 and the death rate from 22% to 5%.

Secretin and somatostatin in the treatment of upper gastrointestinal haemorrhage

Secretin inhibits gastric secretion of acid and gastrin in dog and a physiological role of secretin as an enterogastrone has been suggested in this species. In man there are diverging results concerning the effect of secretin on gastric secretion. Secretin has been used in patients with upper gastrointestinal bleeding and positive results have been reported, but the patients included in these studies cannot be considered as massive bleeders. Until now no double-blind study comparing secretin with placebo has been reported. Somatostatin decreases splanchnic blood flow and gastric secretion in man. Somatostatin seems to be effective in achieving initial haemostasis in patients with bleeding oesophageal varices. The peptide has also been shown to stop severe and persistent peptic ulcer haemorrhage and to stop bleeding in patients treated with steroidal and non-steroidal anti-inflammatory drugs. In one double-blind trial in patients with upper gastrointestinal bleeding, somatostatin had no effect on either the number of emergency operations or the number of rebleedings. In another double blind study, when somatostatin was compared with placebo in patients with massive upper gastrointestinal bleeding, the peptide reduced the number of emergency operations. In conclusion, most studies show positive effects of somatostatin on variceal and peptic ulcer haemorrhage.

The treatment of chronic recurrent pancreatitis with depot secretin--a preliminary report

Increased viscosity and raised lactoferrin, trypsin and protein concentrations in selectively aspirated pancreatic secretion, prompted us to try depot secretin therapy in patients with advanced chronic recurrent pancreatitis without pancreatic duct obstruction or pancreatic pseudocysts. The idea behind this approach was that it might "wash out" the sticky, protease-rich secretion. In a randomized double-blind trial we administered depot secretin at doses of 800 CU by subcutaneous injection twice daily for 7 days. Pancreatic secretion from the treatment group had significantly lower viscosities and lactoferrin and trypsin concentrations than in the placebo group. There was also significant pain relief. Depot secretin therapy appears to offer an alternative approach to the management of advanced chronic recurrent pancreatitis without pancreatic duct obstruction or pseudocysts.

Ceruletide-induced acute pancreatitis in the dog and its amelioration by exogenous secretin

Large pharmacological doses of ceruletide administered to conscious dogs by intravenous (i.v.) infusion uniformly induce a severe acute necrotizing pancreatitis within 4 h. High-dose i.v. secretin administered for a period of 24 h after cessation of ceruletide infusion resulted in a significant amelioration of the acute pancreatitis compared to non-secretin-treated dogs with acute pancreatitis. Light microscopy of the pancreas in secretin-treated dogs revealed a significant decrease in edema, polymorphonuclear leukocyte infiltration, cell necrosis and acinar cell vacuolization. Serum amylase levels in secretin-treated dogs were significantly decreased compared to non-secretin-treated dogs. The results of this study suggest that high-dose i.v. secretin exerts a beneficial effect on pre-established, ceruletide-induced acute pancreatitis in dogs.

Haemodynamic effects of pharmacological doses of secretin in patients with impaired left ventricular function

The haemodynamic effects of secretin 4 CU/kg.h was studied in seven patients with impaired left ventricular function. Cardiac output (P less than 0.01) and stroke volume (P less than 0.05) increased persistently during the infusion period, whereas the total systemic resistance fell (P less than 0.01). Heart rate increased slightly (P less than 0.01). The systemic arterial pressure was unchanged except for a small, transient reduction at the onset of the infusion (P less than 0.01). The pulmonary capillary wedge pressure, the pulmonary artery pressure and the pulmonary arteriolar resistance were unaltered. In patients with depressed cardiac function, pharmacological doses of secretin increased left ventricular performance by means of arteriolar dilation and a positive inotropic effect is also suggested.

Caerulein-induced acute necrotizing pancreatitis in mice: protective effects of proglumide, benzotript, and secretin

The onset, course, and regression of the biochemical and structural alterations associated with pancreatitis induced by various doses of caerulein were studied in the mouse. In addition, the protective effect of secretin was compared with that of the cholecystokinin-receptor antagonists proglumide and benzotript. Subcutaneous or intraperitoneal injections of caerulein induced increases in serum amylase concentration and pancreatic weight and histologic evidence of acute pancreatitis, all effects being dose-related. Cytoplasmic vacuoles were the earliest histologic alterations. As the pancreatitis progressed these vacuoles increased to an enormous size. Interstitial inflammation and acinar cell necrosis were prominent after 6 h, reached a maximum after 12 h, and mostly disappeared after 4 days. During the course of pancreatitis approximately 40% of the acinar cells showed signs of severe degeneration or necrosis at the most effective doses of caerulein. Electron microscopy showed both intact and degenerating granules inside the vacuoles. Signs of basolateral exocytosis of zymogen granules were not observed. During the regression of pancreatitis, focal atrophy was a remarkable histologic finding. Repetitive initiation of pancreatitis (six courses of caerulein injections over 5 wk) produced marked focal atrophy and early fibrosis. High doses of proglumide or benzotript markedly ameliorated both the biochemical and structural alterations induced by caerulein. Secretin, even at very high doses, had only minor protective effects. This study presents a model of acute necrotizing pancreatitis in which the severity of the induced pancreatitis ranges dose-dependently from mild interstitial inflammation to severe necrosis. The ultrastructural alterations described herein support the hypothesis that the trigger mechanism of acute pancreatitis appears to be a primary intracellular event rather than an interstitial event that secondarily damages the acinar cells.

Inhibitory effects of secretin on gastrin-stimulated rat colon neoplasms

A study was done to determine if continuous administration of exogenous secretin would inhibit the trophic effect of elevated endogenous gastrin on colon neoplasms in rats. Colon tumors were induced in 37 Fisher rats by subcutaneous injection of 1,2-symdimethylhydrazine, 20 mg/kg, weekly for 18 weeks. Elevation of endogenous gastrin was achieved by antral exclusion surgery. Control rats received a sham operation. Subcutaneous osmotic minipumps delivered 35.5 U/kg/day of secretin for 7 days before the rats were killed. Rats receiving antral exclusion had significantly elevated serum gastrin levels and increased 3H-thymidine incorporation into tumor DNA compared with sham rats (P less than 0.05). There was a significant decrease in tumor DNA uptake in antral exclusion rats that received secretin as compared with antral exclusion rats without secretin (P less than 0.05). Therefore it appears that gastrin does have a trophic effect on rat colon neoplasms and that secretin does inhibit this effect, in a dose-related manner. The results of this study imply that hormonal manipulation of colon cancer may eventually become a viable therapeutic modality.

Effect of elcatonin on experimental gastric and duodenal ulcers

The antiulcer action of elcatonin, an analogue of natural eel calcitonin, was compared with that of cimetidine, secretin and solcoseryl. Elcatonin (3 to 10 mu/kg, s.c.) inhibited the development of gastric ulcers induced by pylorus ligation, water-immersion stress, aspirin and reserpine and duodenal ulcers induced by cysteamine in rats. Moreover, once daily injections of elcatonin (1 to 10 mu/kg/day, s.c.) promoted the healing of acetic acid-induced chronic gastric ulcers not only in rats but in dogs. The healing effect persisted after the cessation of administrations. Cimetidine (30 to 100 mg/kg, p.o.) inhibited the development of gastric ulcers induced by water-immersion stress, aspirin and reserpine and duodenal ulcers induced by cysteamine in rats. However, once daily administrations of cimetidine (30 to 100 mg/kg/day, p.o.) did not show significant effect on acetic acid-induced chronic gastric ulcers in rats. Secretin (30 to 100 mu/kg, s.c.) inhibited the development of gastric ulcers induced by pylorus ligation, water-immersion stress, aspirin and reserpine in rats, but was not effective on cysteamine-induced duodenal ulcers and acetic acid-induced chronic gastric ulcers in rats. Solcoseryl (2 ml/kg, s.c.) inhibited only the development of water-immersion stress-induced gastric ulcers in rats. These results suggest that elcatonin is different from these reference drugs in its properties of action on experimental ulcers. Mechanisms of the antiulcer action of elcatonin which has a superior effect on experimental ulcers are discussed.

pH-control via secretin or antacid: prophylaxia of stress ulcers in high-risk surgical patients

The efficacy of an antacid or synthetic secretin in elevating the intragastric pH above 4 was tested in a controlled, prospective study. Twenty-one high-risk surgical patients received an antacid and 17 secretin. Antacid prophylaxis resulted in a significantly higher intragastric pH than with secretin. This was especially true in patients with several risk factors. The percent of secretin patients with a pH below 4 was higher. An increase in dosage was necessary in 4 of the 17 patients receiving secretin and in none of those receiving antacids. One stress ulcer hemorrhage occurred during secretin prophylaxis.

Stimulation of bile output by gastrointestinal hormones following portoenterostomy for biliary atresia

For biliary atresia portoenterostomy with externally draining conduit provides a model for quantitation of hepatic excretory function and for assessment of the physiologic response of the intrahepatic biliary system to gastrointestinal hormones in a human hepatopathologic condition. Four patients with biliary atresia were serially evaluated from 2 weeks to 43 months following total bile diverting portoenterostomy. A fifth patient with no bile flow provided a control for these studies. The pattern of Rose Bengal excretion for three patients with a satisfactory clinical course was different from that of a fourth patient with highly variable flow and persistent cholestasis. Marked volume and bicarbonate concentration increases in bile were noted 30 to 45 minutes after secretin infusion but only in the four patients with bile flow. The volume response to glucagon was more diffuse. Bilirubin and bile acid concentrations decreased in the stimulated bile flow periods and hourly outputs of these cholephils were not increased above basal. During two intervals of low bile output, secretin markedly increased bile flow in the patient with persistent cholestasis establishing the patency of the hepatoenteric anastomosis (functional obstruction) in contrast to the lack of secretin response in the control (structural obstruction).

[Intragastric pH increase using antacids or secretin for stress ulcer prevention in surgical risk patients]

The efficacy of an antacid or synthetic secretion on elevations in intragastral pH above 4 was tested in a controlled prospective study. 21 surgical high risk patients received an antacid, and 17 secretin. Antacid prophylaxis resulted in a significantly higher intragastral pH than with secretin. This was especially true in patients with several risk factors. The percentage of secretin patients with a pH reduction below 4 was higher. An increase in dosage was necessary in 4 of the 17 patients receiving secretin and in none of those receiving antacids. One stress ulcer hemorrhage occurred during secretin infusion.

Protective effects of exogenous secretin on ceruletide-induced acute pancreatitis in the rat

Unconscious rats given intravenous ceruletide (diethylamine salt of the decapeptide caerulein) in large pharmacologic doses consistently developed moderate acute pancreatitis by 3 h and florid pancreatitis by 6 h. Biochemical serum markers of acute pancreatitis tended to parallel the severity of the pancreatic damage. In 50% of the rats, mesenteric fat necrosis was present, free peritoneal fluid containing massive elevations of trypsinogen and amylase were noted in most animals. Intravenous secretion at a low dose given simultaneously with ceruletide exerted a variable protective effect on the pathological process. A high dose of secretin produced a striking macroscopic, microscopic, and biochemical protective effect on ceruletide-induced pancreatitis. High resolution light microscopy and electron microscopy showed a marked cellular disorganization in the acini of animals treated with ceruletide alone. By contrast, there was a striking apical redirection of zymogen granules in acini of the animals treated with secretin. The results of this study suggest that high dose intravenous secretin may exert a beneficial effect on acute pancreatitis.

[Treatment of duodenal ulcer with synthetic depot secretin - a double-blind study]

63 inpatients with duodenal ulcer disease were treated with either depot-secretin or placebo. Two different secretin-regimens were used. In group I 18 patients were given secretin twice daily. 11 ulcers from a total of 19 ulcers healed within 3 weeks. In group II 23 patients were given secretin once daily. 21 out of 28 ulcers healed within 3 weeks. In the placebo-treated group 24 ulcers were observed in 22 patients. Of these 15 healed within 3 weeks. There was no statistical difference in the healing rate between the 3 groups. However, depot-secretin significantly improved typical symptoms. Analgetics were used less frequently. Serious side effects did not occur.