The enteral insulin-stimulation after whipple's operation

Rehfeld, Jens F.; Stadil, F.; Baden, H; Fischerman, K

doi:10.1007/bf00422323

Cited by 25 publications

(14 citation statements)

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“…This is further supported by studies on patients with more pronounced hypogastrinemia due to resection of antrum, duodenum, and the proximal jejunum (Whipple's operation). These patients had similarly reduced insulin response to parenteral glucose administration (44). The normal magnitude of the insulin response to oral glucose in hypogastrinemic PA is in accordance with the previously held view (4,16,44) that gastrin in normal and low concentrations plays only a small role as enteral insulin-stimulator during glucose ingestion.…”

Section: Discussionsupporting

confidence: 69%

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Disturbed islet-cell function related to endogenous gastrin release. Studies on insulin secretion and glucose tolerance in pernicious anemia.

Rehfeld¹

1976

J. Clin. Invest.

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A B S T R A C T The insulin and gastrin response to oral glucose, intravenous glucose, or a protein-rich meal were measured in 44 nondiabetic patients with pernicious anemia (PA) and in 44 control subjects. 36 of the PApatients had hypergastrinemia, while serum gastrin concentrations in the remaining eight patients were below normal. Three hypergastrinemic PA-patients were in addition studied during an oral glucose loading with synchronous intravenous infusion of gastrin-17.During both oral and intravenous glucose tests blood glucose concentrations were similar in patients and in controls. After ingestion of protein blood glucose concentrations in PA-patients with hypergastrinemia were above those of the controls (P <0.05). Parenteral infusion of gastrin-17 during oral glucose loading also increased blood glucose concentrations above the levels observed after glucose alone. In PA-patients with hypergastrinemia the insulin response was augmented in all tests. In patients with hypogastrinemia serum insulin concentrations were lower than normal in the fasting state and during stimulation with glucose intravenously (P < 0.01). In hypergastrinemic patients serum gastrin concentrations decreased after oral as well as intravenous glucose administration. The decrease was larger during the oral test. In hypogastrinemia oral glucose induced, as in controls, a small initial rise followed by a slow fall in serum gastrin concentrations. No variations were seen in these patients during the intravenous glucose infusion. Gel filtration of serum from hypergastrinemic patients disclosed a decrease in the concentrations of all Dr. Rehfeld's present address is Institute of Medical Biochemistry, University of Aarhus, DK-8000 Aarhus C, Denmark.Received for publication 1 December 1975 and in rezHsed form 16 February 1976. four main components of gastrin during the glucose loadings.Taken together with earlier studies on the effect of exogenous gastrin the results suggest that endogenous hypergastrinemia induces hyperglycemia and potentiates insulin secretion. In contrast hypogastrinemia is associated with hypoinsulinism.

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Section: Discussionsupporting

confidence: 69%

“…Patients and control subjects 44 patients with treated PA and 44 healthy control subjects participated in the study. All patients and controls were within 10% of their desirable weight (15).…”

Section: Methodsmentioning

confidence: 99%

Disturbed islet-cell function related to endogenous gastrin release. Studies on insulin secretion and glucose tolerance in pernicious anemia.

Rehfeld¹

1976

J. Clin. Invest.

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“…This finding might be explained by drainage of the transplanted pancreas into the systemic circulation instead of the portal vein. The magnitude of the enteral stimulus, i. e. the incretin effect on insulin secretion during OGTT was unchanged after transplantation, suggesting that the incretin effect is not mediated by neural influences upon the endocrine pancreas.Key words: Glucose, incretin, insulin secretion, pancreatic transplantation, pigs.Oral glucose induces an insulin response more than twice as large as that induced by intravenous glucose [1][2][3][4]. The mechanism behind this phenomenon, termed incretin [5], has received much attention, but its nature has not yet been entirely explained.…”

mentioning

confidence: 99%

“…The incretin effect has mainly been conceived as being of hormonal nature [6][7][8][9][10][11]. However, it might also be due to neural augmentation of the insulin response [4,[12][13][14], though until now no studies have excluded this possibility.The present study was designed to evaluate the necessity of pancreatic innervation on the incretin effect in pigs by studying the effect of heterotopic pancreatic allotransplantation on the insulin responses to oral and intravenous glucose administration. …”

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The enteral insulin-stimulation after pancreas transplantation in the pig

1976

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Summary. The insulin responses to an oral glucose tolerance test (OGTT) and in intravenous glucose infusion (IVGI), designed to copy the changes in serum glucose concentrations found during OGTT, were measured in four pigs before and after heterotopic pancreatico-duodenal allotransplantation and total pancreatectomy. After transplantation and total pancreatectomy a remarkable hyperinsulinaemia occurred during OGTT and IVGI, reflected by an almost two-fold increment in the insulinogenic index after transplantation. This finding might be explained by drainage of the transplanted pancreas into the systemic circulation instead of the portal vein. The magnitude of the enteral stimulus, i. e. the incretin effect on insulin secretion during OGTT was unchanged after transplantation, suggesting that the incretin effect is not mediated by neural influences upon the endocrine pancreas.Key words: Glucose, incretin, insulin secretion, pancreatic transplantation, pigs.Oral glucose induces an insulin response more than twice as large as that induced by intravenous glucose [1][2][3][4]. The mechanism behind this phenomenon, termed incretin [5], has received much attention, but its nature has not yet been entirely explained. The incretin effect has mainly been conceived as being of hormonal nature [6][7][8][9][10][11]. However, it might also be due to neural augmentation of the insulin response [4,[12][13][14], though until now no studies have excluded this possibility.The present study was designed to evaluate the necessity of pancreatic innervation on the incretin effect in pigs by studying the effect of heterotopic pancreatic allotransplantation on the insulin responses to oral and intravenous glucose administration. Material and MethodsEight healthy pigs of Danish Landrace weighing 29-34 kg were used in the study.The operative procedure has been described in detail previously [15]. In short, total pancreaticoduodenectomy was performed in the donor pig, with resection of an 8 cm long segment of aorta containing both the coeliac and the superior mesenteric arteries. In the recipient pigs pancreaticoduodenal transplantation was as follows: The infrarenal vena cava and the abdominal aorta were exposed for approximately 8 cm. The distal end of the donor aortic segment was anastomosed end-to-side to the abdominal aorta of the recipient and the donor portal vein joined end-to-side to the inferior vena cava of the recipient. The duodenal segment was anastomosed end-to-side to the upper part of jejtmum. Total Pan7 createctomy was performed in the recipient pig one week after transplantation. Penicillin was given during the first postoperative week. Immunosuppressive therapy was not given.The mean survival time of the four pigs was 73.5 days (range 35-98 days). They remained normoglycaemic for an average of 63.3 days (range 21-91 days). During the investigative period all pigs were in good clinical condition without any signs of malabsorptive disorders. After death the pigs were autopsied and, to insure that there were no remaining pa...

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Effect of truncal vagotomy on gastroduodenal content of gastrin

Malmstrøm

Stadil

Christensen

1977

Journal of British Surgery

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The vagal influence on gastroduodenal content of gastrin was studied in duodenal ulcer patients. Endoscopic biopsies were assayed for total concentrations of gastrin, and fractionated for measurements of gastrin components before and after total vagotomy. Antral concentration was 17-0 +/- 2-0 mug gastrin/g mucosa (mean +/- s.e.m.) in 52 unoperated patients compared with 25-2 +/- 3-2 mug in 32 vagotomized patients. In 14 patients studied before and 3 months after vagotomy antral content was almost doubled (10-9 +/- 2-3 and 20-4 +/- 2-9 mug respectively). In the duodenal bulb the concentration was 2-4 +/- 0.3 mug in 37 unoperated patients and 2-2 +/- 0.4 mug in 19 vagotomized patients. In 6 patients in whom measurements were made throughout the duodenum, gastrin concentrations were slightly but significantly lower 3 months after vagotomy. Fractionations of pooled homogenates on Sephadex G-50 showed that gastrin component III (gastrin-17) made up 95 per cent of the antral gastrins before and after operation. In the duodenum component III constituted more than half of the gastrins preoperatively, but only one-third postoperatively. The total amount of gastroduodenal gastrin was considerably increased by vagotomy, and it is well established that in serum the gastrin concentration is also higher postoperatively. The most likely implication of these findings is that in man the vagus, directly or indirectly, suppresses gastrin production.

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The enteral insulin-stimulation after whipple's operation

Cited by 25 publications

References 14 publications

Disturbed islet-cell function related to endogenous gastrin release. Studies on insulin secretion and glucose tolerance in pernicious anemia.

Disturbed islet-cell function related to endogenous gastrin release. Studies on insulin secretion and glucose tolerance in pernicious anemia.

The enteral insulin-stimulation after pancreas transplantation in the pig

Effect of truncal vagotomy on gastroduodenal content of gastrin

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