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Pandol SJ. The Exocrine Pancreas. San Rafael (CA): Morgan & Claypool Life Sciences; 2010.

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The Exocrine Pancreas.

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Clinical Application of Knowledge of Pancreatic Physiology

The understanding of the physiologic mechanisms involved in mediating pancreatic secretion during the intestinal phase of a meal can be utilized for clinical strategies. There are situations where it is necessary to provide nutrients to the intestinal tract of an individual without activating pancreatic secretions. One example occurs in patients with acute pancreatitis. This is a severe inflammatory disease of the exocrine pancreas that is made worse with stimulation of the exocrine pancreas [48]. This clinical need has led to investigations in humans to determine whether administration of alternative nutrients or delivery of nutrients to the jejunum rather than the duodenum may result in less activation of the pancreatic secretory response. Some examples are listed.

Studies in normal human volunteers compared the effect of equicaloric amounts of long fatty acid chain (long-chain) triglycerides and medium-chain triglycerides, infused into the jejunum, on plasma CCK levels and pancreatic secretion [175]. Long-chain triglycerides stimulated both an increase in CCK levels and pancreatic secretion while medium-chain triglycerides had no effect. Thus, with respect to jejunal administration, medium-chain triglycerides can be used to provide an energy source without significantly stimulating the pancreas.

Another study in healthy volunteers compared the effects of duodenal infusions of a complex liquid diet with those of an elemental (protein as amino acids) diet with low fat content [176]. Noteworthy was the finding of significantly less pancreatic secretion with the elemental diet than with the complex liquid diet. The combination of the findings in these two studies demonstrates that delivery of a diet with minimal need for digestion (i.e., elemental and medium-chain triglycerides) directly to the intestinal lumen bypassing the cephalic and gastric phases can provide nutrients with minimal stimulation of pancreatic secretions, an important strategy for providing nutrition to patients with acute pancreatitis.

Another clinical condition where application of knowledge of the mechanisms of pancreatic secretion has been used to develop treatments is chronic pancreatitis. Patients with this disorder have a chronic inflammatory and fibrosing process of the pancreas that is associated with constant and sometimes severe abdominal pain. Often, the pain is worsened with intake of a meal presumably due to stimulation of the pancreas. In some of these patients, oral administration of high doses of pancreatic enzymes alleviates the abdominal pain [177]. The mechanism of pain relief likely involves the feedback inhibition of pancreatic secretion discussed above.

Copyright © 2011 by Morgan & Claypool Life Sciences.
Bookshelf ID: NBK54137

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