Pancreatic function was measured by duodenal aspiration after injection of secretin and cholecystokinin in malnourished children from Dakar and Abidjan, West Africa, and in age- and sex-matched control subjects from Dakar, Abidjan, and Marseille, France. Compared with French control subjects, pancreatic function was moderately decreased in Abidjan control subjects and more severely in Abidjan subjects with kwashiorkor. Pancreatic insufficiency was as severe in patients as in control subjects in Dakar. After a well-balanced diet was fed for 5 d, all kwashiorkor symptoms disappeared. In Abidjan pancreatic secretion levels increased but remained lower than in control subjects. After 28 d feeding, the pancreatic secretion of kwashiorkor patients in Dakar was not modified. Pancreatic extracts had no effect on changes in pancreatic insufficiency after feeding. In West Africa there is a latent pancreatic insufficiency involving water, electrolytes, and enzymes, which is more severe in Dakar, where, in contrast to Abidjan, it is neither aggravated by kwashiorkor nor corrected by feeding.

One hundred nineteen children, either French or from the Ivory Coast, aged 1-8 years, were submitted to pancreatic function testing by duodenal aspiration. Trypsin, chymotrypsin, lipase, phospholipase, amylase, volume, bicarbonate, chloride, and calcium were estimated before and after an intravenous injection of 1 CU secretin + 3 CHR units pancreozymin per kilogram of body weight. Sixty-two patients were normal European children, and 11 were normal African children. Twenty-five African children presented with kwashiorkor and 10 African children had presented with kwashiorkor but had recovered at the time of the test. Three cases of recurrent kwashiorkor are also included. In the normal group of African children, phospholipase concentration, volume, and bicarbonate were significantly decreased but chymotrypsin and trypsin concentrations were not, when compared to the normal European population. In kwashiorkor patients, lipase, amylase, phospholipase, and chymotrypsin concentration were significantly decreased compared to normal Africans. Trypsin, volume, and bicarbonate were not affected. These modifications disappeared after refeeding. In cases of recurrent kwashiorkor, all enzymes, including trypsin, were decreased. Calcium was never modified. These modifications were very different from those observed in chronic alcoholic and hypercalcemic pancreatitis. In a two-year study, chronic calcifying pancreatitis (CCP) was diagnosed in 14 patients (13 males), hospitalized in Abidjan. The mean age at onset of the disease was 41 years (SD 12.71), which is very similar to European cases. The most frequent cause was alcoholism, as in Occidental countries. The nutrition of the population was low in protein, calories being provided mostly by manioc, but no apparent symptoms of malnutrition were observed in the parents of our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

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Secretin and cholecystokinin-pancreozymin had no effect on the secretion of human gastric lipase, in contrast to pentagastrin, which increased the gastric lipase output but not the enzyme concentration in gastric juice. The secretion of gastric lipase was not significantly different in patients with duodenal ulcer or chronic pancreatitis and in controls. In contrast, basal gastric lipase concentration was significantly lower in children with cystic fibrosis than in normal children. This shows that neither in adults nor in children is there a compensation for a decreased lipase secretion by an increased gastric lipase secretion.

Pure pancreatic juice composition was studied, after secretin and cerulein stimulation in 29 people from Burundi (Central Africa): 17 controls and 12 alcoholic chronic pancreatitis (CP) patients. Results were compared to similar data in France. African controls had a similar pancreatic response to hormones apart from a much lower lipase secretion than French controls. In the early non-calcified stage of African CP water and bicarbonate secretion were markedly diminished while protein and lipase concentrations were enhanced. In the late stage, secretion was exhausted except that of calcium. Nutritional data were obtained under the same conditions in 40 African controls and in 34 CP patients (including all patients tested for secretion). African controls had a very low fat intake (35.2 ± 2.6g/day), and patients had a higher protein and fat intake (144.7 ± 5.9 and 66.2 ± 4.8g/day, respectively) than local controls: as in other countries, CP was associated with a diet enriched in alcohol, fat and protein.

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