Effects of the pancreas functional condition on the duration of the latent period of pancreatic secretion in patients with chronic biliary pancreatitis and post-cholecystectomy syndrome

Abstract

Objective — to investigate the duration of the latent period (LP) of pancreatic secretion in patients with chronic biliary pancreatitis (CBP) and post‑cholecystectomy syndrome (PCHES) depending on the state of excitation and inhibition processes in pancreas and the volume of stimulated pancreatic secretion. Materials and methods. Examinations involved 362 patients with CBP (121 men and 241 women, aged 18 to 70 years (the mean age 34.3±11.13 years) and 53 patients with PCHES (13 men and 40 women), aged 25 to 68 years (mean age 53.68±7.43 years). The pancreas function was evaluated by the method of complex gastroduodenal investigation, modified in our clinic (author`s certificate N 942711; 1982). As a stimulator of pancreatic secretion, 30 ml of 0.1M HCl solution was used. The state of excitation and inhibition processes in pancreas was evaluated by measuring the pressure in the antral stomach department (ASD) during the stimulated pancreatic secretion with the use of an open catheter method with the pressure recorder («Saturn», Ukraine). The ASD pressure of 0 — 5 mm Hg was considered as a feature of the balance of excitation and inhibition processes in pancreas, pressure 6 — 9 mm Hg as the boundary stress of the inhibition process, і 10 mm Hg — inhibition failure, and unstable pressure (combination of two or three pressure types) related to the imbalance due to weakness of the inhibition process. The duration of pancreatic secretion LP of 4 — 5 min and stimulated pancreatic secretion 181 — 260 ml were considered as normal. Statistical significance of differences between groups was assessed using a non‑parametric test χ2. For pairwise comparisons, Yates’ correction and Bonferroni correction were applied. Results. In patients with CBP and PCHES duration of LP of pancreatic secretion was 4 — 5, 6 — 8, 9 — 10 and ≥11 min. Duration of LP of pancreatic secretion in group of patients with CBP with unstable ASD pressure and in group of patients with PCHES with unstable ASD pressure differed significantly (p <0.001). The percentage of LP 4 — 5, 6 — 8 and 9 — 10 min in group of patients with CBP was significantly higher and the percentage of LP 11 min and longer was significantly lower in comparison with the group of patients with PCHES (p <0.015; p <0.015 and p <0.075). Duration of LP of pancreatic secretion in group of patients with CBP with unstable ASD pressure and in group of patients with CBP with ASD pressure ≥10 mm Hg also were significantly different (p <0.05). The percentage of LP 4 — 5 min in group of patients with unstable ASD pressure was significantly higher and the percentage of LP ≥11 min was significantly lower in comparison with the group of patients with ASD pressure ≥10 mm Hg (p <0.05). In group of patients with CBP with ASD pressure 0 — 5 mm Hg, LP ≥11 min was observed in 7.33% of patients and was absent in the same group of patients with PCHES. It was concluded that in patients with CBP and PCHES with imbalance of processes of excitation and inhibition in pancreas, LP lengthening causes the weakness of the process of inhibition, that results in the weakness of excitation process. In patients with CBP with imbalance of processes of excitation and inhibition in pancreas there is also a braking influence of gallbladder. In patients with CBP with balance of processes of excitation and inhibition in pancreas lengthening of LP causes braking influence of gallbladder. It was also concluded, that within LP of pancreatic secretion takes place complete or partial recovery of the balance of processes of excitation and inhibition in pancreas, and it also may cause lengthening of LP of pancreatic secretion. Conclusions. Duration of LP of pancreatic secretion depends on the state of the process of excitation of pancreatic secretion, degree of the imbalance of excitation and inhibition processes in pancreas and presence of gallbladder disorders. In patients with PCHES, LP of pancreatic secretion is prolonged in comparison with the patients with CBP because of inborn weakness of the excitation process of pancreatic secretion and considerable imbalance of excitation and inhibition processes in pancreas. The normalization of gallbladder motor‑evacuation function is required for restoration of LP normal duration in patients CBP with the balanced processes of excitation and inhibition, whereas patients with CBP and PCHES with imbalance of excitation and inhibition processes in pancreas require additional duodenal stimulation of pancreas with HCl solution.