Pancreatic Exocrine and Endocrine Responses in Chronic Pancreatitis

To test the discriminatory potential of certain indices of pancreatic function we performed duodenal perfusion studies and measured trypsin, bicarbonate, and lactoferrin outputs, and plasma concentrations of pancreatic polypeptide and motilin in the basal state and during continuous intravenous stimulation with 100 kg kg^‐1h^‐1 Ceruletide and 1 CU kg^‐1h^‐1 secretin. The following groups were studied: 12 normal volunteers (NV), seven patients with chronic pancreatitis with steatorrhea (CPS), and seven without steatorrhea (CP). Stimulated trypsin outputs, after 45 min of stimulation, were the best discriminant among the groups (NV versus CPS, p < 0.0005; NV versus CP, p < 0.005; CP versus CPS, p < 0.05). Basal trypsin outputs showed similar patterns but failed to discriminate between NV and CP. Bicarbonate outputs were less discriminatory than trypsin outputs. Lactoferrin outputs failed to discriminate, but transient high peak outputs occurred in the initial stimulation period in all four patients with calcific chronic pancreatitis, suggesting a washout phenomenon. Basal motilin levels were elevated in both groups of pancreatitis (p < 0.05). Stimulated pancreatic polypeptide levels were lower in CPS (NV versus CPS, p < 0.05) but higher in CP (NV versus CP, p < 0.005). These differences were also apparent in the basal state. We conclude that the best discrimination among the three groups was achieved by measurement of trypsin outputs, after 45 min of stimulation. In addition, the pancreatic poly peptide response may be used as a marker of residual pancreatic function in chronic pancreatitis.