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Asensio-Grau A, Calvo-Lerma J, Heredia A, Andrés A. Fat digestibility in meat products: influence of food structure and gastrointestinal conditions. Int J Food Sci Nutr 2018; 70:530-539. [DOI: 10.1080/09637486.2018.1542665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Andrea Asensio-Grau
- Instituto de Ingeniería de Alimentos para el Desarrollo, Universitat Politècnica de València, Valencia, Spain
| | - Joaquim Calvo-Lerma
- Instituto de Ingeniería de Alimentos para el Desarrollo, Universitat Politècnica de València, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe, Hospital Universitario La Fe, Valencia, Spain
| | - Ana Heredia
- Instituto de Ingeniería de Alimentos para el Desarrollo, Universitat Politècnica de València, Valencia, Spain
| | - Ana Andrés
- Instituto de Ingeniería de Alimentos para el Desarrollo, Universitat Politècnica de València, Valencia, Spain
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Asensio-Grau A, Peinado I, Heredia A, Andrés A. Effect of cooking methods and intestinal conditions on lipolysis, proteolysis and xanthophylls bioaccessibility of eggs. J Funct Foods 2018. [DOI: 10.1016/j.jff.2018.05.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Prevalence of Small Intestinal Bacterial Overgrowth among Chronic Pancreatitis Patients: A Case-Control Study. Can J Gastroenterol Hepatol 2016; 2016:7424831. [PMID: 27446865 PMCID: PMC4904664 DOI: 10.1155/2016/7424831] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/18/2015] [Indexed: 02/06/2023] Open
Abstract
Background. Patients with chronic pancreatitis (CP) exhibit numerous risk factors for the development of small intestinal bacterial overgrowth (SIBO). Objective. To determine the prevalence of SIBO in patients with CP. Methods. Prospective, single-centre case-control study conducted between January and September 2013. Inclusion criteria were age 18 to 75 years and clinical and radiological diagnosis of CP. Exclusion criteria included history of gastric, pancreatic, or intestinal surgery or significant clinical gastroparesis. SIBO was detected using a standard lactulose breath test (LBT). A healthy control group also underwent LBT. Results. Thirty-one patients and 40 controls were included. The patient group was significantly older (53.8 versus 38.7 years; P < 0.01). The proportion of positive LBTs was significantly higher in CP patients (38.7 versus 2.5%: P < 0.01). A trend toward a higher proportion of positive LBTs in women compared with men was observed (66.6 versus 27.3%; P = 0.056). The subgroups with positive and negative LBTs were comparable in demographic and clinical characteristics, use of opiates, pancreatic enzymes replacement therapy (PERT), and severity of symptoms. Conclusion. The prevalence of SIBO detected using LBT was high among patients with CP. There was no association between clinical features and the risk for SIBO.
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Naughton V, Hedemann MS, Naughton PJ, McSorley E, Laerke HN. Duodenal application of Li+ in a submaximal therapeutic dose inhibits exocrine pancreatic secretion and modulates gastro-duodenal myoelectrical activity in a conscious pig model. Can J Physiol Pharmacol 2013; 91:764-72. [DOI: 10.1139/cjpp-2012-0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study tested whether duodenal application of lithium inhibits gastroduodenal motility, and whether it suppresses secretion from the exocrine pancreas. Five suckling pigs, 16–18 days old, were surgically fitted with 3 serosal electrodes on the wall of the gastric antrum and the duodenum for electromyography of smooth muscles, and with a pancreatic duct catheter and a duodenal T-cannula for collection and re-entrant flow of pancreatic juice. After the recovery period, on alternative days, each animal was tested once with an intraduodenal infusion of Li+ (100 mmol·L–1C3H5LiO3,10 mL·kg−1·h−1) for 1 h, and once with an intraduodenal infusion of NaCl (154 mM, 10 ml·kg−1·h−1), also for 1 h, with the first treatment, i.e., Li+ or NaCl, randomly assigned. Individual pigs served as their own controls, with data recorded prior to a treatment being used as the baseline. Li+ increased the duration of quiescence (P < 0.05) and activity phase (P < 0.05) in the antrum, thus increasing (P < 0.05) the duration of antral myoelectrical cycles. Li+ shortened (P < 0.05) phase I, but it did not affect phase II or phase III or the MMC in the duodenum. Li+ inhibited pancreatic juice outflow as well as pancreatic enzyme and bicarbonate output (P < 0.05 for all pancreatic parameters).
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Affiliation(s)
- Violetta Naughton
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, County Londonderry BT52 1SA, UK
| | - Mette S. Hedemann
- Department of Animal Science, Faculty of Science and Technology, Århus University, Blichers Allé 20, PO Box 50, DK-8830 Tjele, Denmark
| | - Patrick J. Naughton
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, County Londonderry BT52 1SA, UK
| | - Emeir McSorley
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Cromore Road, Coleraine, County Londonderry BT52 1SA, UK
| | - Helle N. Laerke
- Department of Animal Science, Faculty of Science and Technology, Århus University, Blichers Allé 20, PO Box 50, DK-8830 Tjele, Denmark
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Airinei G, Gaudichon C, Bos C, Bon C, Kapel N, Bejou B, Raynaud JJ, Luengo C, Aparicio T, Levy P, Tome D, Benamouzig R. Postprandial protein metabolism but not a fecal test reveals protein malabsorption in patients with pancreatic exocrine insufficiency. Clin Nutr 2011; 30:831-7. [DOI: 10.1016/j.clnu.2011.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/30/2011] [Accepted: 06/12/2011] [Indexed: 10/18/2022]
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Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol 2011; 4:55-73. [PMID: 21753892 PMCID: PMC3132852 DOI: 10.2147/ceg.s17634] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Indexed: 12/14/2022] Open
Abstract
Pancreatic enzyme replacement therapy is currently the mainstay of treatment for nutrient malabsorption secondary to pancreatic insufficiency. This treatment is safe and has few side effects. Data demonstrate efficacy in reducing steatorrhea and fat malabsorption. Effective therapy has been limited by the ability to replicate the physiologic process of enzyme delivery to the appropriate site, in general the duodenum, at the appropriate time. The challenges include enzyme destruction in the stomach, lack of adequate mixing with the chyme in the duodenum, and failing to deliver and activate at the appropriate time. Treatment is begun when clinically significant malabsorption occurs resulting in steatorrhea and weight loss. Treatment failure is addressed in a sequential fashion. Current research is aimed at studying new enzymes and delivery systems to improve the efficiency of action in the duodenum along with developing better means to monitor therapy.
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Affiliation(s)
- Aaron Fieker
- Division of Digestive Diseases, University of Oklahoma, OKC, OK, USA
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Giuliano CA, Dehoorne-Smith ML, Kale-Pradhan PB. Pancreatic enzyme products: digesting the changes. Ann Pharmacother 2011; 45:658-66. [PMID: 21540403 DOI: 10.1345/aph.1p770] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To review the pharmacology, dosage regimens, efficacy, and safety of currently marketed pancreatic enzyme products (PEPs). DATA SOURCES Studies were identified by PubMed (1966-January 2011), clinicaltrials.gov, fda.gov, and International Pharmaceutical Abstracts. Search terms included pancreatic enzyme, lipase, Creon, Zenpep, Pancreaze, and exocrine pancreatic insufficiency (EPI). STUDY SELECTION AND DATA EXTRACTION All human studies evaluating the efficacy of currently approved or potential PEPs were reviewed. DATA SYNTHESIS PEPs are composed of porcine lipase, amylase, and protease and are used in patients with EPI secondary to cystic fibrosis, chronic pancreatitis, and pancreatectomy. In 1938, PEPs were exempted from the Food, Drug, and Cosmetic Act of 1938 and never underwent a formal Food and Drug Administration (FDA) review process. In response to reports of treatment failures during product interchange, the FDA conducted a review of available PEP products. This review found a large variability of response between the unapproved PEP products, which resulted in the FDA requiring approval of all PEP products by April 2010. The 3 delayed-release, enteric-coated PEPs currently approved by the FDA (Creon, Zenpep, and Pancreaze) have demonstrated efficacy and safety in EPI secondary to cystic fibrosis. Creon has also demonstrated safety and efficacy in EPI secondary to chronic pancreatitis and pancreatectomy. Cost difference between the 3 products is minimal. Treatment-related adverse events in clinical studies for all PEPs were less than or similar to those with placebo. CONCLUSIONS At this time, Creon is an appropriate first-line agent, as it has been approved for chronic pancreatitis, pancreatectomy, and cystic fibrosis.
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Affiliation(s)
- Christopher A Giuliano
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, St. John Hospital and Medical Center, Detroit, MI
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Krishnamurty DM, Rabiee A, Jagannath SB, Andersen DK. Delayed release pancrelipase for treatment of pancreatic exocrine insufficiency associated with chronic pancreatitis. Ther Clin Risk Manag 2009; 5:507-20. [PMID: 19707261 PMCID: PMC2710383 DOI: 10.2147/tcrm.s3196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Pancreatic enzyme supplements (PES) are used in chronic pancreatitis (CP) for correction of pancreatic exocrine insufficiency (PEI) as well as pain and malnutrition. The use of porcine pancreatic enzymes for the correction of exocrine insufficiency is governed by the pathophysiology of the disease as well as pharmacologic properties of PES. Variability in bioequivalence of PES has been noted on in vitro and in vivo testing and has been attributed to the differences in enteric coating and the degree of micro-encapsulation. As a step towards standardizing pancreatic enzyme preparations, the Food and Drug Administration now requires the manufacturers of PES to obtain approval of marketed formulations by April 2010. In patients with treatment failure, apart from evaluating drug and dietary interactions and compliance, physicians should keep in mind that patients may benefit from switching to a different formulation. The choice of PES (enteric coated versus non-enteric coated) and the need for acid suppression should be individualized. There is no current standard test for evaluating adequacy of therapy in CP patients and studies have shown that optimization of therapy based on symptoms may be inadequate. Goals of therapy based on overall patient presentation and specific laboratory tests rather than mere correction of steatorrhea are needed.
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Kojecky V, Bernatek J, Horowitz M, Zemek S, Bakala J, Hep A. Prevalence and determinants of delayed gastric emptying in hospitalised Type 2 diabetic patients. World J Gastroenterol 2008; 14:1564-9. [PMID: 18330949 PMCID: PMC2693753 DOI: 10.3748/wjg.14.1564] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the prevalence of delayed gastric emptying (GE) in older patients with Type 2 diabetes mellitus.
METHODS: One hundred and forty seven patients with Type 2 diabetes, of whom 140 had been hospitalised, mean age 62.3 ± 8.0 years, HbA1c 9.1% ± 1.9%, treated with either oral hypoglycemic drugs or insulin were studied. GE of a solid meal (scintigraphy), autonomic nerve function, upper gastrointestinal symptoms, acute and chronic glycemic control were evaluated. Gastric emptying results were compared to a control range of hospitalised patients who did not have diabetes.
RESULTS: Gastric emptying was delayed (T50 > 85 min) in 17.7% patients. Mean gastric emptying was slower in females (T50 72.1 ± 72.1 min vs 56.9 ± 68.1 min, P = 0.02) and in those reporting nausea (112.3 ± 67.3 vs 62.7 ± 70.0 min, P < 0.01) and early satiety (114.0 ± 135.2 vs 61.1 ± 62.6 min, P = 0.02). There was no correlation between GE with age, body weight, duration of diabetes, neuropathy, current glycemia or the total score for upper gastrointestinal symptoms.
CONCLUSION: Prolonged GE occurs in about 20% of hospitalised elderly patients with Type 2 diabetes when compared to hospitalised patients who do not have diabetes. Female gender, nausea and early satiety are associated with higher probability of delayed GE.
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Schnelldorfer T, Adams DB. Efficacy of Feeding Tube Placement during Pancreaticoduodenectomy for Chronic Pancreatitis. Am Surg 2007. [DOI: 10.1177/000313480707301215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malnutrition, intestinal dysmotility, and gastroparesis are frequent problems in patients with chronic pancreatitis who undergo pancreaticoduodenectomy. This has led to the practice of operative placement of enteral feeding tubes. The purpose of this study is to examine the efficacy of feeding tubes placed during pancreaticoduodenectomy in patients with chronic pancreatitis. The records of 78 consecutive patients who underwent pancreaticoduodenectomy for chronic pancreatitis were retrospectively reviewed and analyzed. Forty-nine patients who received feeding tubes at the time of operation were compared with 29 who did not have feeding tubes placed. Both groups had similar disease progress measured by duration of symptoms and preoperative nutritional status. During the observation period, there was a trend toward not using operative feeding tubes (first 6 years 84 per cent versus last 2 years 33%). The overall complication rate after pancreaticoduodenectomy was 54 per cent. Placement of a feeding tube was associated with an increase in intra-abdominal morbidity from 34 per cent to 57 per cent ( P < 0.03). None of the patients had a complication directly related to placement of the feeding tube. Eighty-eight per cent of the placed feeding tubes were used. Despite feeding tube placement, 49 per cent of patients with feeding tubes required postoperative use of total parenteral nutrition compared with 55 per cent of patients without feeding tubes ( P > 0.05). Length of hospital stay and hospital readmission during the first postoperative year were not affected by feeding tube placement. In conclusion, simultaneous feeding tube placement along with pancreatic head resection for chronic pancreatitis can be performed safely. The majority of the feeding tubes are used in postoperative care, but they do not prevent the need for total parenteral nutrition and do not shorten length of hospital stay.
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Affiliation(s)
- Thomas Schnelldorfer
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - David B. Adams
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Schnelldorfer T, Lewin DN, Adams DB. Operative management of chronic pancreatitis: longterm results in 372 patients. J Am Coll Surg 2007; 204:1039-45; discussion 1045-7. [PMID: 17481536 DOI: 10.1016/j.jamcollsurg.2006.12.045] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 12/15/2006] [Indexed: 01/16/2023]
Abstract
BACKGROUND Operative treatment of chronic pancreatitis is indicated for patients with intractable pain after failed medical and endoscopic treatment, or for the presence of complications of the disease. This study evaluates a single-center experience with operative management of chronic pancreatitis. STUDY DESIGN The records of 372 consecutive patients who underwent lateral pancreaticojejunostomy (n = 184), pancreaticoduodenectomy (n = 97), or distal pancreatectomy (n = 91) for chronic pancreatitis between 1995 and 2003 were retrospectively reviewed and analyzed. Longterm outcomes were assessed by patient survey, with a median followup of 5.5 +/- 0.2 years. RESULTS Primary indication for operative treatment included intractable pain (n = 215), pancreatic duct disruption (n = 109), inflammatory mass (n = 42), or biliary obstruction (n = 6). Perioperative morbidity was 22%, 51%, and 29% after lateral pancreaticojejunostomy, pancreaticoduodenectomy, and distal pancreatectomy, respectively, with a perioperative mortality rate of 1%. Two hundred twenty-eight patients were available for longterm followup. Fifty-eight patients (25%) died in the followup period. Twenty-four percent of the remaining 170 patients were pain free, and 25% had good pain control after the procedure. On multivariate analysis, risk factors for poor pain control were pancreaticoduodenectomy (p < 0.01), preoperative narcotic dependence (p < 0.02), earlier abdominal operations (p < 0.02), and an absent history of gallstone pancreatitis (p < 0.05). Sixty-two percent returned to work. Quality of life assessed by SF-36 version 2 questionnaire showed norm-based scores between the 35th and 46th percentile and slightly below, but not substantially different from, a general population. New onset of endocrine and exocrine insufficiency was present in 35% and 29% of patients, respectively. CONCLUSIONS Operative management of chronic pancreatitis can be performed with low mortality and acceptable morbidity. Surgical treatment can provide good pain control, return patients to work, and achieve a satisfactory quality of life in the majority of patients. Longterm mortality is high in a subset of patients.
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Affiliation(s)
- Thomas Schnelldorfer
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
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Rosa-E-Silva L, Troncon LEA, Gallo L, Foss MC, Passos ADC, Perdoná GC, Achcar JA, Oliveira RB. Factors associated with abnormal gastric emptying in alcohol-related chronic pancreatitis. J Clin Gastroenterol 2007; 41:306-11. [PMID: 17426472 DOI: 10.1097/01.mcg.0000225582.55459.dd] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with alcohol-related chronic pancreatitis (ARCP) may present with abnormal gastric emptying (GE), which has been ascribed mainly to nutrient maldigestion. Nevertheless, many patients also have diabetes with autonomic dysfunction and malnutrition and the role of these factors on abnormal GE has not been investigated. GOALS To determine the influences of malabsorption, diabetes, malnutrition, and autonomic dysfunction on GE abnormalities in patients with ARCP. STUDY Forty ARCP outpatients and 18 healthy controls were studied. GE was measured by scintigraphy after a standard, liquid, nutrient meal labeled with Technetium-phytate. Autonomic function was evaluated by cardiovascular tests. The influence of each factor on abnormal GE was assessed by Bayesian multiple regression analysis. RESULTS In the ARCP group, GE was abnormal in 19 patients (47.5%), who showed either accelerated (N=12) or delayed emptying (N=7). Diabetes was highly prevalent (P<0.01) in ARCP patients with either rapid or delayed GE (18/19). Multiple regression analysis showed that not only diabetes, but also autonomic dysfunction has significant effects on abnormal GE, whereas malabsorption and malnutrition seemed not to be associated to abnormal emptying. CONCLUSIONS A substantial proportion of patients with ARCP may have abnormal GE. Either delayed or accelerated GE seem to be related to underlying diabetes mellitus and autonomic neuropathy rather than to nutrient malabsorption and malnutrition.
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Affiliation(s)
- Lucilene Rosa-E-Silva
- Department of Medicine, Londrina School of Medicine, State University of Londrina, Londrina, State of Paraná, Brazil
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Hornum M, Larsen S, Olsen O, Pedersen JF. Duplex ultrasound of the superior mesenteric artery in chronic pancreatitis. Br J Radiol 2006; 79:804-7. [PMID: 16822799 DOI: 10.1259/bjr/41916828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Blood flow in the superior mesenteric artery (SMA) increases after a meal due to a vasoactive effect of the decomposed food. In exocrine pancreatic insufficiency, the digestion of food is compromised. We used duplex ultrasound to test the hypothesis that blood flow in the SMA after a meal increases less in patients with pancreatic insufficiency than in control persons. We studied 16 patients with chronic pancreatitis, eight of them with exocrine insufficiency, and eight healthy volunteers. The resistive index (RI) in the SMA was determined before and after a liquid meal. The RI reflects the downstream circulatory resistance, giving a precise description of mesenteric hyperaemia. Both groups of patients with chronic pancreatitis unexpectedly had lower fasting RI than controls, 0.818 and 0.815 vs 0.851, p = 0.028 and p = 0.0030, respectively. Postprandialy there was significantly less decrease in RI (less increase in flow) in patients with exocrine insufficiency than in controls, 0.055 vs 0.099, p = 0.0047. There was a significant trend for a less pronounced postprandial decrease in RI with more impaired pancreatic function (p = 0.0036). Our study thus demonstrates a reduced postprandial increase in SMA flow in patients with exocrine pancreatic insufficiency, and suggests an increased fasting SMA flow in chronic pancreatitis. Further studies are needed to evaluate the possible role of the test-meal-induced shift in RI in the SMA and of a lower-than-normal fasting RI in the diagnosis and monitoring of chronic pancreatitis.
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Affiliation(s)
- M Hornum
- Department of Gastroenterology, Glostrup Hospital, Copenhagen, Denmark
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Symersky T, Biemond I, Frolich M, Masclee AAM. Effect of peptide YY on pancreatico-biliary secretion in humans. Scand J Gastroenterol 2005; 40:944-9. [PMID: 16173137 DOI: 10.1080/00365520510015863] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The negative feedback on pancreatico-biliary secretion induced by ileal nutrients has been well documented but the role of the distal gut peptide YY (PYY) as mediator is less well defined. We determined the effect of PYY on basal, sham feeding and feeding-stimulated pancreatico-biliary secretion in humans. MATERIAL AND METHODS Eight healthy volunteers participated in a placebo-controlled, double-blind, randomized study with intravenous infusion of a physiological dose of PYY. Subjects were intubated with a naso-jejunal tube. Duodenal samples were aspirated continuously while a recovery marker perfused the duodenum. Outputs were measured in the basal state, in response to modified sham feeding (MSF) and during jejunal perfusion with a liquid meal. Blood samples were drawn for plasma cholecystokinin (CCK) and PYY measurements. RESULTS PYY infusion significantly (p<0.01) increased plasma PYY, from 16+/-2 to 55+/-6 pM. Basal outputs of amylase, lipase, trypsin and bilirubin were not affected by PYY. In the placebo experiment, MSF significantly increased amylase, lipase, trypsin and bilirubin outputs. However, during PYY infusion lipase, trypsin and bilirubin outputs did not significantly increase in response to MSF. Jejunal feeding, however, significantly (p<0.01) increased the outputs of bilirubin and enzymes equally during both the placebo and PYY infusions. CONCLUSIONS Infusion of PYY to physiological plasma levels exerts an inhibitory effect on pancreatico-biliary secretion during the cephalic phase of digestion, but not in the basal state or during the intestinal phase. PYY suppresses pancreatico-biliary secretion during the cephalic phase but not during the intestinal phase of nutrient digestion.
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Affiliation(s)
- Tomas Symersky
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Lu CL, Chen CY, Luo JC, Chang FY, Lee SD, Wu HC, Chen JDZ. Impaired gastric myoelectricity in patients with chronic pancreatitis: Role of maldigestion. World J Gastroenterol 2005; 11:372-6. [PMID: 15637747 PMCID: PMC4205340 DOI: 10.3748/wjg.v11.i3.372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether gastric myoelectrical activity was impaired in patients with chronic pancreatitis (CP) and to explore the role of pancreatic enzyme in regulating gastric myoelectrical activity.
METHODS: Twenty CP patients and 20 controls participated in the study. Gastric myoelectrical activity was recorded by a homemade electrogastrography (EGG) device. Two experiments were carried out. In experiment one, EGG was recorded in both controls and CP patients. While in experiment two, either pancreatic enzymes or placebo was given together with test meals. Spectral analysis was used to generate various EGG parameters.
RESULTS: The control subjects, but not the CP patients, showed typically increased postprandial dominant frequency. The postprandial dominant power (DP) increment (2.24±1.13 vs 5.35±0.96 dB, P = 0.04) and the percentage of normal 2-4 cpm slow waves (63.0±3.8% vs 77.4 ±3.1%, P<0.05) were lower in CP patients when compared with the control. In the 20 CP patients, the DP increment (4.76±1.02 vs 2.53±1.20 dB, P<0.05) and the postprandial percentage of normal 2-4 cpm (74.4±2.8% vs 64.8 ±5.7%, P<0.05) were significantly higher with pancreatic enzyme replacement than the placebo.
CONCLUSION: CP patients have an abnormal postprandial stomach myoelectricity showing poor response in dominant frequency/power and regularity, whereas these abnormalities are corrected after pancreatic enzyme replacement. Maldigestion is likely to be the factor leading to abnormal postprandial gastric myoelectricity of CP patients.
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Affiliation(s)
- Ching-Liang Lu
- Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan, China.
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Symersky T, Vu MK, Frölich M, Biemond I, Masclee AAM. The effect of equicaloric medium-chain and long-chain triglycerides on pancreas enzyme secretion. Clin Physiol Funct Imaging 2002; 22:307-11. [PMID: 12487002 DOI: 10.1046/j.1475-097x.2002.00435.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It has been shown previously that medium chain triglycerides (MCT) do not affect gallbladder emptying and cholecystokinin (CCK) release. The effect of MCT on exocrine pancreas secretion in humans is unknown. We have compared the effect of enteral administration of MCT versus long chain triglycerides (LCT) on exocrine pancreatic secretion. Eight healthy subjects (three female, five male; mean age 22 +/- 1.9 years) participated in two experiments, performed in random order. Duodenal contents, obtained by aspiration, were used to calculated the output of pancreatic enzymes and bilirubin. An equicaloric amount of either MCT or LCT (2 kcal min-1) oil was continuously administered in the proximal jejunum for 2 h. Gallbladder volume was measured by ultrasonography and blood samples were drawn for determination of CCK. The experiments consisted of 1 h basal secretion, 2 h of continuous oil administration and 1 h poststimulation. During the LCT feeding the pancreatic enzyme secretion, bilirubin output, gallbladder emptying and CCK release increased significantly (P < 0.05) over basal levels. MCT had no effect on pancreatic enzyme secretion nor gallbladder emptying or CCK release. We conclude that enteral administration of MCT in the proximal jejunum does not stimulate exocrine pancreatic secretion nor gallbladder contraction or CCK release, in contrast to an equicaloric amount of LCT.
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Affiliation(s)
- T Symersky
- Department of Gastroenterology-Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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Ohtsuka T, Takahata S, Ohuchida J, Takeda T, Matsunaga H, Yokohata K, Yamaguchi K, Chijiiwa K, Tanaka M. Gastric phase 3 motility after pylorus-preserving pancreatoduodenectomy. Ann Surg 2002; 235:417-23. [PMID: 11882764 PMCID: PMC1422448 DOI: 10.1097/00000658-200203000-00014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze factors affecting the recovery course of phase 3 activity of the gastric migrating motor complex after pylorus-preserving pancreatoduodenectomy (PPPD) and investigate effects of the recovery of gastric phase 3 on gastric emptying after feeding. SUMMARY BACKGROUND DATA Whether early recovery of gastric phase 3 during fasting would predict early recovery of the fed-state gastric emptying function after PPPD has not been well documented. METHODS Manometric recording from the gastric antrum was repeated at a weekly interval until the first appearance of gastric phase 3 in 57 patients after PPPD. Twenty-three clinical parameters were assessed as possible factors affecting the recovery course of gastric phase 3 by simple and multiple regression analyses. A gastric emptying study after feeding of a test meal was performed by the acetaminophen method and the values were compared between patients with and without gastric phase 3 after PPPD. RESULTS The mean period before the first appearance of gastric phase 3 was 38 days. Among 23 parameters, only lymph node dissection along the hepatoduodenal ligament significantly delayed recovery of gastric phase 3 after PPPD by univariate and multivariate analyses. The presence or absence of gastric phase 3 in the early postoperative period did not influence gastric emptying after feeding in the intermediate period after PPPD. CONCLUSIONS Avoiding lymph node dissection along the hepatoduodenal ligament, if applicable, may contribute to early recovery of gastric phase 3 after PPPD. The recovery state of gastric phase 3 during fasting, however, is not necessarily consistent with the degree of improvement of gastric emptying after feeding.
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Affiliation(s)
- Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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