Effect of Pancreatic Surgery on Proximal and Distal Gut Hormone Secretion.
Abstracts
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Background: In patients with chronic pancreatitis (CP) alterations in gastrointestinal (GI) hormone release have been described. Little is known on the influence of different surgical procedures for CP on GI hormone release. Aim of the study was to evaluate hormone secretion after two types of pancreatic surgery: pylorus preserving pancreaticoduodenectomy (PPPD) and duodenum preserving resection of the head of the pancreas (DPRHP) for CP. Methods: We studied secretion of the proximal gut hormone cholecystokinin (CCK) and the distal gut hormone peptide YY (PYY) in response to a 500 Kcal mixed meal in patients after PPPD (n=22; age 46-78 yr), DPRHP (n=9; age 28-66 yr), non operated CP patients (n=12; age 25-70 yr), and healthy controls (n=14; age 20-72 yr). Results: Basal plasma CCK levels were not sign. different between the groups. The postprandial peak increment in plasma CCK in patients after PPPD (0.6 ( 0.1 pM) was sign. lower compared to that in patients after DPRHP (1.7 ( 0.3 pM; p<0.01), CP patients (1.5 ( 0.2 pM; p<0.01) and controls (2.4 ( 0.1 pM; p<0.01). Integrated plasma CCK secretion in patients after PPPD (25 ( 6 pM(120 min) was also significantly lower compared to patients after DPRHP (86 ( 32 pM(120 min; p<0.05), and CP patients (84 ( 17 pM(120 min; p<0.01). In all patients groups CCK secretion was sign. reduced compared to controls (170 ( 15 pM(120 min; p<0.01). Basal plasma PYY in patients after PPPD (35 ( 2 pM) was sign. higher compared to patients after DPRHP (24 ( 3 pM; p=0.01) and CP patients (23 ( 1 pM; p<0.01). Integrated postprandial PYY secretion was higher in CP, DPRHP and PPPD (1140 ( 280, 760 ( 310, 960 ( 210 pM(120 min) versus controls (610 ( 90 pM(120 min; p<0.1 to p<0.05). Conclusions: In patients with CP proximal hormone secretion is decreased and distal hormone secretion is increased versus healthy controls. After pancreatic surgery without resection of the duodenum no significant changes in proximal or distal hormone secretion compared to CP are found, whereas after PPPD proximal hormone secretion is decreased and distal hormone secretion is increased. |
