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Pituitary adenylate cyclase activating polypeptide (PACAP) is a multifunctional neuropeptide with widespread occurrence throughout the body including the gastrointestinal system. In the small and large intestine, effects of PACAP on cell proliferation, secretion, motility, gut immunology and blood flow, as well as its importance in bowel inflammatory reactions and cancer development have been shown and reviewed earlier. However, no current review is available on the actions of PACAP in the stomach in spite of numerous data published on the gastric presence and actions of the peptide. Therefore, the aim of the present review is to summarize currently available data on the distribution and effects of PACAP in the stomach. We review data on the localization of PACAP and its receptors in the stomach wall of various mammalian and non-mammalian species, we then give an overview on PACAP’s effects on secretion of gastric acid and various hormones. Effects on cell proliferation, differentiation, blood flow and gastric motility are also reviewed. Finally, we outline PACAP’s involvement and changes in various human pathological conditions.

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Background and aim. The safety and effectiveness of an HPN program depends on both the expertise and the management procedures of the HPN center. We aimed to know the modalities needed to provide the home parenteral nutrition (HPN)-program and the types of intravenous supplementation (IVS)-admixtures supplied to patients with chronic intestinal failure (CIF) in different countries. Methods. In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Results. HPN-provider: HCC 66%, LP 34%; no difference between benign-CIF and malignant-CIF. LP was the main modality in 11 Countries; HCC prevailed in 4 European countries, Israel, USA, South America and Oceania (p<0.001). IVS-admixture: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA+PAFE use was greater in malignant-CIF and CA+CAFE use was greater in benign-CIF (p<0.001). PA+PAFE prevailed in those Countries where LP was the main HPN-provider and CA+CAFE prevailed where the main HPN-provider was HCC (p<0.001). Conclusions. The HPN provision and the IVS-admixture types differ greatly among countries, among HPN centers and between benign-CIF and malignant-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed, to give patients the same opportunity to receive appropriate HPN therapy.

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