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Background/Aims-The period of refeeding in patients with acute pancreatitis is critical because they may have pain

Exocrine pancreas from different species behaves differently in response to the presence of intact or digested nutrients in the duodenum. A failure of cholecystokinin (CCK) release after a meal has been shown among patients with exocrine pancreatic insufficiency. This abnormality could be restored by the administration of pancreatic extracts, suggesting that digested rather than intact nutrients are responsible for the release of CCK and subsequently gallbladder contraction in humans. The aim of this study was to determine the specific role of different lipidic stimuli in humans. Seven male patients (mean age, 52 years) with pancreatic insufficiency secondary to chronic pancreatitis were selected. Pancreatic insufficiency was considered severe in five of them (lipase output, <1,000 IU/ min) and moderate in another two (lipase output, >1,000 and <2,300 IU/min). Plasma CCK (by bioassay), gallbladder contraction (by ultrasound), and enzyme output (chymotrypsin) in response to duodenal administration of either oleic acid as free fatty acids or 20% Intralipid as triglycerides were measured in each patient with at least a 48-h interval between each test. In all these patients with pancreatic insufficiency, duodenal perfusion of free fatty acids generated a more pronounced (9 1 ? 1 1 vs. 49 ? 21 pM) and faster (15 vs. 30 min) ( p < 0.05) CCK release than triglycerides. Furthermore, gallbladder contraction was more efficient when free fatty acids instead of triglycerides were administered in the duodenum (86 t 5 vs. 69 * 4%) at 10 min (p < 0.05) and (73 & 8 vs. 5 1 ? 5 % ) at 15 min 0, < 0.03).

The increase of postprandial maximal levels of cholecystokinin is more related to malnutrition than to aging.

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