SUMMARY The dose response of duodenal bicarbonate production during synthetic porcine secretin infusions was studied in six healthy volunteers and related to plasma secretin immunoreactivity. Secretin was infused in each individual at four different doses from 0

Carefully measured contrast medium instillation and generalized antibiotic prophylaxis lowered the post-ERCP pancreatitis rate from earlier values of 7.38°/o to present values of 1.3°/o. Additional administration of aprotinin and glucagon has no further prophylactic effects.

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SUMMARY Graded doses of 0 1, 0*3, 0 9, and 2-7 clinical units/kg/h of pure synthetic secretin were infused over 60 minute periods in six healthy volunteers. Duodenal bicarbonate output and pH were recorded and plasma secretin and motilin levels were measured by radioimmunoassay. During the infusions plasma motilin fell in a dose dependent manner to a nadir of 35 %. This fall was linearly correlated with pancreatic bicarbonate output, whereas a non-linear correlation was observed between plasma motilin and both plasma secretin level and duodenal pH. It is suggested that plasma motilin levels are decreased by secretin-induced pancreatic bicarbonate juice flow. This may be important for the control of motilin secretion initiated by duodenal acidification and the concomitant delay in gastric emptying.Motilin, a recently discovered hormonal peptide from the small intestine (Brown et al., 1971), has been shown to increase lower oesophageal sphincter pressure and to delay gastric emptying in man (Ruppin et al., 1975; Rosch et al., 1976).So far, no physiological regulation of motilin secretion has been ascertained. In the dog it has been reported that serum motilin levels are raised by strong duodenal alkalinisation (Dryburgh and Brown, 1975). We have shown recently that, in man, motilin is released by duodenal acidification and after intraduodenal instillation of tris buffer (pH 102) motilin fell . As, however, a duodenal pH of 10-2 is unlikely to be achieved under normal conditions, the significance of this finding is uncertain. The present study was designed to assess the effect on motilin release of secretin. This peptide initiates a physiological alkalinisation of the duodenum by stimulating endogenous alkaline pancreatic juice flow (Jorpes and Mutt, 1961). MethodsSix healthy volunteer men (aged 23-42 years) were "Address for reprint requests:

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