Long-Term Effects on the Regulation of Pancreatic Secretion after Gastric Surgery

Abstract

Background: Apart from smoking, known risk factors for the development of pancreatic carcinoma are few, gastric resection being proposed as one. The trophic effect of cholecystokinin (CCK) on the pancreatic gland is well known from animal experience and increased concentrations of CCK in plasma have been shown to induce pancreatic neoplasia experimentally. In several studies the release of CCK in response to food ingestion has been shown to be increased following gastric surgery. However, in those studies, the time between surgery and investigation of the CCK response was short, and methods of CCK analysis have since improved. Patients and Methods: In patients, partially gastrectomized 8 years (median) earlier, we studied the plasma concentrations of CCK, insulin and gastrin, as well as some specific pancreatic enzymes. The findings were compared to an age-matched control group of individuals not subjected to gastric surgery. Results: Basal CCK concentrations in the operated group were found to be lower, but increased postprandially to the same level as in controls. Serum levels of specific pancreatic enzymes were equal in the 2 groups. Conclusion: It is possible that a disturbed regulation of pancreatic secretion, or a secretory dysfunction within the gland, following partial gastrectomy, could contribute to the development of pancreatic carcinoma. However, our findings do not favor the idea of plasma CCK as a promotor of pancreatic carcinoma.

Pathophysiological Effects of Nicotine on the Pancreas: An Update

“…Tobacco smoking, diabetes mellitus, cholelithiasis, and pancreatitis increase the risk of pancreatic cancer (92). Hedberg and colleagues (93) found that a disturbed regulation of pancreatic enzyme secretion, or a regulatory dysfunction of the pancreatic gland, could contribute to the development of pancreatic carcinoma in patients after partial gastrectomy. Their studies suggest that the hormone CCK, which was shown to induce experimental neoplasia, is not involved in this phenomenon.…”

Veränderungen im gastrointestinalen Hormonhaushalt nach Gastrektomie: Was ist klinisch relevant?

“…Die Gastringesamtsekretion nach Stimulation ist um 43% niedriger als bei nichtoperierten Kontrollpatienten [9]. In einer klinischen Studie von Hedberg et al [33] findet sich auch 8 Jahre nach Billroth-II-Resektion kein Gastrinanstieg im Nahrungsstimulationstest [33]. Die erniedrigten Gastrinkonzentrationen nach Gastrektomie erlangen mo È glicherweise auch klinische Bedeutung bei der Entstehung der exokrinen Pankreasinsuffizienz nach Gastrektomie [34].…”