Singer MV. Pancreatic secretory response to intestinal stimulants. Scand J Gastroenterol 1987, 22(suppl 139), 1-13In humans and many laboratory animals, protein digestion products such a s peptides and amino acids and fat digestion products such as fatty acids and monoglycerides are potent intestinal stimulants of pancreatic cnzymc secretion. The pancreatic enzyme response to these intestinal stimulants is related to thc pcrfuscd load (amount per unit time) rather than to concentration. Both neural and hormonal pathways mediate the enzyme response t o thesc intestinal stimulants. Enteropancreatic, cholinergic, vago-vagal reflexes are probahly the most important mediators of the enzyme response to low loads of amino acids and fatty acids; hormones, such ;IS cholecystokinin, seem to be the major mediators of the response to high loads of amino acids and fatty acids. Under physiological conditions it is prohahly thc interplay o f neural and hormonal mechanisms which regulates the pancreatic response to these stimulants. Gastric acid is the major regulator of postprandial pancreatic bicarbonate secretion. Secretin released by HCI is probably the most important physiological hormonal mediator of postprandial pancreatic bicarbonate secretion; its effect heing potentiated by extrinsic (vagal) and intrinsic (intrapancreatic) cholincrgic nerves and rclease of other hormones, such as cholecystokinin. , vagal and splanchnic; pancreatic bicarbonate and enzyme response; sccretin Pro6 sirarsklinik, Hufelandstr. 55, 0-4300 Essen I , FRC Dr. Manfred V . Singer, Ahteilung Casrroenrrologie, Medizinische Unioer-Scand J Gastroenterol Downloaded from informahealthcare.com by University of Sydney on 01/03/15 For personal use only. Scand J Gastroenterol Downloaded from informahealthcare.com by University of Sydney on 01/03/15 For personal use only. No effect No effect No effect Depressed (low loads) Scand J Gastroenterol Downloaded from informahealthcare.com by University of Sydney on 01/03/15For personal use only.
Background/Aims: The prevalence and incidence of autoimmune pancreatitis (AiP) in those living in western countries are largely unknown. We aimed to determine the prevalence of AiP among patients with pancreatitis presenting to our tertiary referral center in Mannheim, Germany; and to estimate the incidence of AiP in the Southwest of Germany. Methods: We performed a retrospective cross-sectional analysis and determined the prevalence of AiP in patients with acute pancreatitis (AP) or chronic pancreatitis (CP). Patients (n = 704; alcoholic pancreatitis n = 373, nonalcoholic pancreatitis n = 331) were stratified into the Retrospective-Pancreas-Cohort (RPC, period 1998-2008, n = 534) and the Pancreas-Clinic-Cohort (PCC, periods 2008-2010 and 2013-2014, n = 170, with detailed investigation for features of AiP). Diagnosis of AiP was established by International-Consensus-Diagnostic-Criteria and Unifying-Autoimmune-Pancreatitis-Criteria. Results: In the RPC, the prevalence of AiP was 5.9% (n = 13/221) among individuals with nonalcoholic pancreatitis (n = 1/61 with AP, 1.6%; n = 12/160 with CP, 7.5%). In the PCC, the prevalence of AiP was 9.1% (n = 10/110) among patients with nonalcoholic pancreatitis (n = 2/24 with AP, 8.3%; n = 8/86 with CP, 9.3%), and 1.7% (n = 1/60) among subjects with alcoholic pancreatitis. We estimated the incidence of AiP with 0.29 per 100,000 population each year. Conclusion: The prevalence rate of AiP may account for 9% of patients with nonalcoholic pancreatitis but is almost never observed in patients with alcoholic pancreatitis. The incidence of AiP in Germany appears lower than 1 per 100,000 population.
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