Impaired response of main pancreatic duct to secretin stimulation in early chronic pancreatitis

Abstract

In the present study we compared sonographic measurements of the main pancreatic duct (MPD) following maximal secretin stimulation (75 CU intravenous in 1 min) in 15 chronic pancreatitis patients (CP) with those of 18 normal control subjects. The mean caliber of the main pancreatic duct was 1.2 +/- 0.4 mm in controls and 1.8 +/- 0.9 in patients with chronic pancreatitis (P less than 0.025). In the control group a dilatation of the duct with a peak at the third minute was found. In patients with chronic pancreatitis a flatter profile of the response curve with a slower increase and inconstant return to basal values was found. A statistically significant difference was found between absolute variations of MPD caliber over basal values (1.7 +/- 1.06 in controls vs 0.8 +/- 0.69 in CP, P less than 0.005) and the dilatation index [(Dmax - D)/D] (1.31 +/- 0.6 in controls vs 0.66 +/- 0.69 in CP, P less than 0.005). The mean percent increase at the third minute was 131% in control subjects vs 53% of patients with CP (P less than 0.0005). In the five cases of CP showing a caliber increase greater than 100%, a persistent dilatation (100-200%) was found 15 min after secretin administration. At this time, the mean percent increase over basal value in controls was 25%.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of Secretin on Serum Pancreatic Enzymes and on the Wirsung Duct in Chronic Nonpathological Pancreatic Hyperenzymemia

“…Indeed, the modifications of the Wirsung duct observed after secretin administra-Gullo/Ventrucci/Barakat/Migliori/ Tomassetti/Pezzilli tion in the subjects with CNPH were the same as those observed in controls, and were also similar to those reported in normal subjects in other studies [3,4]. Therefore it is clear from these observations that the Wirsung duct and the alterations in its caliber after secretin administration are not involved in the hyperenzymemia.…”

“…A high resolution real-time Ansaldo AU 450 scanner (Ansaldo, Genoa, Italy) using a 3.5-MHz transducer was used for ultrasonographic examinations. The method for measurement has been described in detail in previous studies [3,4].…”

Comparison of Secretin-Stimulated Magnetic Resonance Pancreatography and Manometry Results in Patients with Suspected Sphincter of Oddi Dysfunction

“…Recently, secretin-enhanced MRP has been proposed as a reliable test for assessment of pancreatic exocrine function, as patients with chronic pancreatitis have a reduced increase in pancreatic duct diameter after secretin stimulation (14,30). In patients with possible SOD, the factors influencing the response of pancreatic duct diameter following secretin stimulation are more complex and involve not only secretory function and duct compliance but also resistance of the sphincter of Oddi to pancreatic outflow.…”

Ultrasonographic Observation of Secretin‐induced Pancreatic Duct Dilation in Healthy Cats

“…In most normal healthy human subjects, secretin induces a maximal dilation of 70–140% over basal pancreatic duct diameter within 1–5 min postsecretin administration 13–18,22 . The pancreatic duct then gradually decreases to approximately 25% over basal value at 15 min postsecretin administration 17 .…”

“…Secretin is a polypeptide hormone that stimulates secretion of bicarbonate from the exocrine pancreas and, in healthy human subjects, causes transient pancreatic duct dilation that is observable sonographically 13–16 . Secretin administration fails to cause pancreatic duct dilation in human patients with chronic pancreatitis, in theory due to the restrictive effects of periductal fibrosis 15–18 . Our purpose was to characterize the effects of exogenous secretin administration on the width of the pancreatic duct in healthy domestic cats.…”