Citrate and Calcium Secretion in the Pure Human Pancreatic Juice of Alcoholic and Nonalcoholic Men and of Chronic Pancreatitis Patients

Abstract

Citrate, calcium and protein have been estimated in pure pancreatic juice after a secretin and a CCK injection in 4 patients presenting with alcoholic calcified pancreatitis (ACP), 10 controls without evidence of pancreatic disease, drinking more than 130g alcohol/day, and 10 controls without evidence of pancreatic disease, drinking less than 20 g alcohol/day. Citrate is normally secreted in the pancreatic juice and this secretion increases in parallel with protein after CCK injection. Citrate secretion is significantly decreased in the two alcoholic groups. Calcium secretion is increased in the ACP, and reasons are presented to suggest that this may be due to lesions of the ducts. These modifications could play a role in the formation of pancreatic stones which are mostly built up of calcium carbonate.

Exocrine Pancreatic Secretion in Normal Controls and Chronic Calcifying Pancreatitis Patients from Burundi: Possible Dietary Influences

“…In European or American alcoholics apparently free of pancreatic lesions, protein concentration and output are increased if the patient is studied in the days following alcohol excess [11. 12], but only concentration is signifi cantly higher than in normal controls if pancreatic juice is collected 1-2 weeks after cessation of alcohol consump tion [9][10][11] while later this difference vanishes [15], Hyperconcentration of protein in the early stage of the disease was expected in view of the biochemical changes of pancreatic juice observed in chronic alcoholic patients and in the experimental data [27], This is now confirmed by the present finding: in cases of early CP. we demonstrate an increase in the total concentration of protein in pancreatic juice, when compared ot local controls; the lipase concen tration, even though the secretory level of lipase was low in that population, was also higher than in controls.…”

“…In contrast, bicar bonate concentration and sometimes output are de creased [ 10,12], the volume being unchanged. There is an increase in the ratio anionic/cationic trypsinogen [14], The concentration and output of citrate, a secretory cal cium chelator, are decreased [15], Calcium and serum protein secretion are increased [15][16][17], This is probably not directly related to alcohol consumption but is second ary to lesions of the ductal epithelium after the onset of CP [18], In a few tropical regions only, such as Kerala (South India) [19], Zaire [20] and Nigeria [21], alcohol consump tion is not the usual cause of CP. In these areas, the dis ease is generally observed in children or young adults, and the possible pathogenetic role of a diet low in protein with a very low fat content has already been emphasized [ 19],…”

Urinary 1H-NMR Metabolomics Can Distinguish Pancreatitis Patients from Healthy Controls

“…These two metabolites could reasonably be expected to differ among pancreatitis patients and healthy controls. Citrate is known to be a significant component of pancreatic secretions [25]. Given that alcohol use or abuse has been associated with a decrease in citrate in pancreatic secretions [26], it is notable that most patients in the chronic pancreatitis and acute pancreatitis groups reported some form of regular alcohol consumption (Table 1).…”

The endoscopic approach to pancreatic duct stones

“…That this deficiency or absence is likely is shown by findings that the messenger RNA responsible for PSP biosynthesis is significantly decreased in the pancreas of patients with chronic calcifying pancreatitis (whether alcoholic or nonalcoholic),11 and PSP concentration related to total protein is significantly decreased in the pure pancreatic juice of these patients 11,17. The two main secretory modifications of pancreatic juice seen in patients with chronic calcifying pancreatitis with plugs and stones are the decreased secretion of both citrate (a potent chelator of calcium)18 and lithostathine. In summary, injury to the pancreas, usually by alcohol, produces a dysregulation of secretion of pancreatic enzymes, citrate, lithostathine, and calcium.…”