STUDIES ON EXOCRINE PANCREATIC FUNCTION - SECRETION OF PROTEIN, CALCIUM AND CITRATE IN PATIENTS WITHOUT PANCREATIC DISEASE AND PATIENTS SUFFERING FROM CHRONIC-PANCREATITIS

Recent studies described an increased concentration of protein and cal cium in association with a decreased concentration of citrate in pancr eatic juice of patients suffering from chronic pancreatitis. These sec retory changes may be of importance in the pathogenesis of chronic pan creatitis. The present study investigates pancreatic juices of 18 pati ents without pancreatic disease and 12 patients in an early phase of c hronic pancreatitis in order to detect changes of the exocrine functio n of the pancreas in an early stage of the disease. In all persons the pancreatic juice was collected by endoscopic cannulation of the main pancreatic duct after i.v. stimulation with secretin and pancreozymin. The outputs and concentrations of protein, calcium and citrate were e stimated. All of these parameters did not differ in control subjects a nd patients with chronic pancreatitis by univariate statistical analys is. However, a multivariate analysis detects differences in the bioche mical composition of the secretions of controls and patients with chro nic pancreatitis (efficiency of discrimination = 100%). Both in contro ls and in patients with chronic pancreatitis two calcium fractions wer e found after secretin stimulation: one secretory protein-associated f raction of 94 nmol calcium/mg protein and a protein-independent calciu m fraction of 0.248 mmol/l, which diffuses paracellularly from the int erstitium into the pancreatic juice. The results show that the secreto ry function of the exocrine pancreas is already disturbed in an early phase of chronic pancreatitis, whereas an increased lithogenity of the pancreatic juice cannot be detected.