ENZYME CONTENT IN SECRETIN-STIMULATED DUODENAL ASPIRATES IS PARADOXICALLY ELEVATED IN PATIENTS WITH CHRONIC PANCREATITIS

Abstract

Secretin primarily stimulates ductal cells to secrete bicarbonate and water. Secretin receptors are also present on acinar cells and may potentiate enzyme secretion. The role of enzyme measurement in secretin testing is not well defined. Aim: To measure enzyme concentration of timed duodenal aspirates in healthy subjects (HS) and patients with chronic pancreatitis (CP) after secretin. Methods: Endoscopically collected duodenal aspirates were obtained from 12 HS and 21 CP patients at 15, 30, and 45 minutes after intravenous secretin (0.2 mcg/kg). Each sample was analyzed for bicarbonate, amylase, lipase, and elastase concentration. Bicarbonate secretory rates were estimated based on timed concentrations (area under curve). Results: The bicarbonate secretory rate was higher for HS compared with CP pts (13 vs. 7 mmol/min, p = 0.01). Lipase and amylase concentrations were higher for CP pts compared with HS [Table]. No difference in elastase was observed.TABLEConclusions: 1. The effect of secretin on bicarbonate (and water) secretion is blunted in patients with chronic pancreatitis. 2. The lipase and amylase concentrations of secretin-stimulated duodenal fluid are paradoxically higher for CP compared with HS. We hypothesize that normal water and bicarbonate in healthy subjects dilutes enzyme content.