Human pancreatic exocrine response to nutrients in health and disease

S3-Leitlinie Chronische Pankreatitis: Definition, Ätiologie, Diagnostik, konservative, interventionell endoskopische und operative Therapie der chronischen Pankreatitis. Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…B. Therapie mit Protonenpumpeninhibitoren bei Einnahme nicht steroidaler Antirheumatika) [323, 342, 348, 350, 352 -359]. Die empfohlene Einstiegsdosis entspricht etwa 5 -10 % der kumulativ nach einer normalen Mahlzeit in das Duodenum sezernierten Lipaseaktivität [360] und sollte deshalb genügen, eine Malabsorption bzw. Steatorrhö zu verhindern [85].…”

Extending in vitro digestion models to specific human populations: Perspectives, practical tools and bio-relevant information

“…The pancreatic juice contains a mixture of enzymes, proenzymes, protease inhibitors, sodium bicarbonate and other electrolytes that are secreted in parallel and gradually over the course of 3e4 h, depending on the meal ingested. The pancreatic secretions contain a variety of enzymes in their proenzyme forms and include protrypsin, prochymotrypsin, proelastase, procarboxypeptidases, pancreatic lipase and a-amylase in addition to ribonuclease and deoxyribonuclease (Boivin, Lanspa, Zinsmeister, Go, & Dimagno, 1990;Keller & Layer, 2005). Currently, IVD models make use of ill-defined mixtures of pancreatin or concoct enzyme mixtures mainly containing trypsin and achymotrypsin.…”

Diagnosis of pancreatic exocrine insufficiency in chronic pancreatitis

“…In an unselected group of patients with chronic pancreatitis, mean pancreatic exocrine function is reduced by around 50-80% compared with healthy controls and 80-90% show some degree of PEI (23). In about 65-75% of patients, morphologic alterations and functional impairment develop in parallel.…”

“…Steatorrhea usually occurs earlier and is more severe than malabsorption of other nutrients. This is explained by an earlier decrease in lipase secretion compared with amylase and proteases (8), higher susceptibility of lipase to acidic pH caused by concomitant impairment of bicarbonate secretion, higher susceptibility of lipase to proteolytic destruction during small intestinal transit, additional acidic denaturation of bile acids and marked inhibition of bile acid secretion in states of malabsorption (23). Moreover, only gastric lipase can serve as an extrapancreatic source of lipolytic activity in humans and this enzyme does not compensate for pancreatic lipase deficiency, although it may be elevated in patients with chronic pancreatitis compared to healthy individuals (3).…”