Remarkable Clinical Improvement of Exocrine Pancreas Insufficiency and Gastritis Syndrome Induced by Citrates: Their Secretin-Releasing Capacity Disclosed in Human Pancreatic Fistula Test

Abstract

Introduction: Following Polak’s personal communication, we decided to elucidate the efficacy of a pharmaceutical mixture of citric acid and citrates in gastritis, dyspeptic syndromes, and exocrine pancreas insufficiency (EPS). Its undisputed success led it to be well known by patients as “magic power.” Objective: To elucidate citrates’ intrinsic physiologic mechanism of action. Methods: Two women (40 and 53 years old, respectively) and 1 man (71 years old) were evaluated with secretin tests (Boots 1,0 U/kg), according to Dreiling’s technique, before and after being subjected to sphincterotomy of Vater’s papilla. Pure pancreatic juice draining from the Wirsung duct by means of an unwilling catheter was collected at 120 minutes. During the first test, following a 30-minute basal period, the 3 patients were given 100 mL of orange lumen juice (OLJ) without sugar. Pure pancreatic juice was collected during its ingestion and for subsequent 30-minute periods. The second test consisted of a regular meal (RM). When recovery from surgery permitted, the 3 patients were given a regular meal consisting of either steak, chicken or fish, green vegetables, mashed potatoes, and a bowl of soup with noodles. As dessert, they received a piece of cheese. As beverage they drank 1 or 2 glasses of mineral water. As they were eating, pure pancreatic juice was collected and this was continued for 120 minutes in 4 30-minute samples. Results: The first OLJ ingestion (100 mL) induced a marked and significant increase of pure pancreatic juice over those of the basal stage (Figure 1). The second RM ingestion showed delayed peak values.Figure 1Conclusion: The present study reveals that a small amount (100 mL) of OLJ exerts an excitatory effect in EPS. The rate of flow as well as bicarbonate and enzyme are of the same order or even greater than those induced by a regular meal. These observations ratify Polak’s finding that the ingestion of a solution of citric acid induces marked and sustained release of secretin. It is surprising and unexpected when the OLJ finding is compared with those of a regular secretin test in which both agents evoke a similar fluid and electrolyte secretin but the enzyme output is greater with the OLJ than with secretin.