IMPAIRED INTERDIGESTIVE PANCREATIC-POLYPEPTIDE RELEASE - EARLY HORMONAL DISORDER IN CHRONIC-PANCREATITIS

The purpose of this study was to investigate interdigestive cycling an d postprandial release of pancreatic polypeptide (PP) in relation to e xocrine pancreatic function in chronic pancreatitis (CP). We investiga ted nine patients with mild-moderate CP (MCP), eight patients with sev ere CP and steathorrea (SCP), and 17 healthy subjects as controls. Int erdigestive antroduodenal motility was monitored by means of manometry . Following two consecutive motility cycles, a standard test meal was administered. Plasma samples were drawn for PP determinations every 15 min throughout the entire study, which concluded 2 hr after ingestion of the meal. Mean interdigestive PP plasma concentrations during phas e III motor activity were lower in MCP (146 +/- 46 pg/ml) than in cont rols (270 +/- 42 pg/ml) and lower still in SCP (55 +/- 8 pg/ml). Accor dingly, the percent increase in PP concentrations during phase III ove r those in phase I was progressively decreased from controls (112%) to MCP (62%) to SCP (19%). Mean interdigestive PP concentrations were al so lower during phase I and II in SCP than in controls or MCP. None of the postprandial parameters for PP release was affected in the early stage of disease, while mean, peak, and integrated postprandial values were significantly lower in SCP than in controls or MCP. Thus, we obs erved a progressive diminution of both interdigestive and postprandial PP release with increasing severity of disease. Interdigestive releas e parameters, in particular, were tightly correlated with exocrine fun ction. CP appears to alter interdigestive PP release to a greater exte nt than postprandial PP release; this effect is already apparent in ea rly stages of the disease. Impaired release of PP during phase III mot or activity may represent an early hormonal disorder in CP.