A Test of Pancreatic Function in Man Based on the Analysis of Duodenal Contents after Administration of Secretin and Pancreozymin

Abstract

Pancreozymin in man as in animals appears to act as a specific enzyme stimulant. The preparations of pancreozymin used in these experiments also contain cholecystokinin, which causes the gall bladder to contract, and a smooth muscle stimulant, possibly substance P.The (Lagerlof, 1939(Lagerlof, , 1942 Diamond, Siegel, Gall, and Karlen, 1939;Diamond andSiegel, 1940, 1941;Comfort and Osterberg, 1940;Pratt, Brugsch, and Rostler, 1940;Pollard, Miller, and Brewer, 1942;Lake, 1947;Dornberger, Comfort, Wollaeger, and Power, 1948;Dreiling and Hollander, 1948, 1950;Friedman and Snape, 1950;Dreiling, 1950Dreiling, , 1951Dreiling, , 1953Dreiling, , 1955 Dreiling and Janowitz, 1957;Wenger and Raskin, 1958).In anaesthetized animals secretin produced a large volume of pancreatic juice of constant alkalinity and low enzyme content. Harper and Raper (1943) isolated from the small intestine a second material, other than secretin, which increased the enzyme output by the pancreas without affecting the volume of juice. This material they named pancreozymin. Crick, Harper, and Raper (1949) later published a revised method of preparing secretin and pancreozymin and preliminary experiments showed that pancreozymin had the same effect on man as in animals

The interrelationships of pancreatic enzymes in human duodenal aspirate

“…'Parallel' secretion of pancreatic enzymes was also reported in response to injections of secretin (Burton, Evans, Harper, Howat, Oleesky, Scott, and Varley, 1960) and of pancreozymin (Burton et al, 1960;Creutzfeldt, 1964;Rick, 1965;Sarles, Figarella, Prezelin, and Souville, 1966;Ammann, Tagwercher, Kashiwagi, and Rosenmund, 1968). On the other hand, Guth, Komarov, Shay, and Style (1956) found statistically significant day-to-day deviations from 'parallelism' in the enzyme response to food in dogs, while Worning and Mullertz (1966) (Burton et al, 1960) Gibbs (1950) showed that the secretion of amylase was sometimes grossly defective in normal infants, whose secretion of trypsin was normal, while Choi, Goldstein, Wirts, and Menduke (1967) recommended the measurement of trypsin because trypsin secretion could be abnormal when amylase secretion remained normal in patients with pancreatic disease. In a much earlier study, Diamond, Siegel, Gall, and Karlen (1939) had already suggested that the practice of estimating only one enzyme was not an adequate measure of total pancreatic capacity to secrete enzymes, because they found frequent dissociation between trypsin and amylase secretion.…”

Continuous Secretin Infusion with Pancreozymin Pretreatment as a Pancreatic Function Test

“…In series reported by the above-quoted authors, the coefficient of variation ranged from 22 to 43%. Several authors, therefore, tried to decrease the variation of enzyme output by stimulating the enzyme secretion with CCK-PZ before or after secretin injection (Marks and Tompsett 1958;Burton et al 1960;Sun and Shay 1960;Dreiling and Janowitz 1962). But, the coefficient of variation in enzyme was not decreased by adding CCK-PZ injection to the secretin test on the whole.…”

Tests of Exocrine Pancreatic Function

“…The volume of juice is abnormally high but the bicarbonate output is usually normal. The response is seen in gall bladder disease, after cholecystectomy and, especially, in cirrhosis and haemochromatosis, (Banwell et al, 1967a;Bode et al, 1972;Burton et al, 1960a;Wormsley, 1970b;Zieve and Mulford, 1967).…”

“…For chronic pancreatitis, pancreatic carcinoma, and "normals" the order of increasing diagnostic accuracy was: scanning, bicarbonate concentration, trypsin output, 8SSe output, 8SSe concentration, hypotonic duodenography, duodenal juice volume. In cases of surgical jaundice, however, the intubation method (Burton et al, 1960a) gives greater accuracy than hypotonic duodenography (Bourke et al, 1972). The addition of cytological examinations to the range of investigations improves the detection rate in cases of carcinoma of the pancreas, bile ducts or ampulla (Bourke et al, 1972;Nundy et al, 1974).…”