Volume Of Pancreatic Juice Research Articles

ID: 3525194 ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND INTRADUCTAL SECRETIN TEST IN THE DIAGNOSIS OF EXOCRINE PANCREATIC INSUFFICIENCY

Chronic Pancreatitis (CP) may be difficult to diagnose in the early stages when imaging may be normal. Exocrine pancreatic insufficiency (EPI) may be considered as a surrogate marker of CP, although not all patients with CP have EPI. During performance of endoscopic retrograde cholangiopancreatography, addition of an Intraductal Secretin Test (IDST) may further aid the evaluation of EPI, based on determination of pure pancreatic juice (PPJ) volume and bicarbonate concentration (BC). The optimal collection time for IDST is unknown.

Cystic fibrosis and exocrine pancreatic insufficiency

Cystic fibrosis (CF) is a genetic disease affecting many organs including the gastrointestinal tract. While the pulmonary damage is the most life threatening, the pancreas is one of the first and most affected organs by CF. Mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene results in a reduced volume of pancreatic juice and hyperconcentration of macromolecules leading to precipitation in the duct lumina, causing obstruction and damage. The clinical presentation of individual cases depends on a combination of different CFTR mutations, potential presence of modifier genes mutations, and environmental factors. The CFTR mutations are historically divided into 5 classes - severe mutations (classes I-III) and mild mutations (classes IV-V). The CFTR functional status depends on the combined effects of both CFTR allels and the severity of the phenotype depends on the milder mutation. The majority of CF patients exhibit exocrine pancreatic insufficiency in early childhood because functional acinar tissue has been lost in utero or soon after birth. These patients rarely suffer from pancreatic complications such as recurrent acute pancreatitis and/or chronic pancreatitis which, on contrary, can occur in the minority of patients who possess residual pancreatic exocrine function. CFTR mutations are found more frequently in idiopathic and alcoholic chronic pancreatitis but the data is conflicting. A combination with SPINK-1 mutations can be found in idiopathic chronic pancreatitis group, as well as presence of environmental factors. Malnutrition is directly related to worse prognosis of CF patients and delivery of active digestive enzymes is a cornerstone of the treatment with acid supression and vitamins supplementation playing an important additional role.

Impact of remnant pancreatic volume and amylase level of pancreatic juice on short- and long-term functional and survival outcomes after pancreatoduodenectomy

Impact of remnant pancreatic volume and amylase level of pancreatic juice on short- and long-term functional and survival outcomes after pancreatoduodenectomy

Role of Endoscopic Retrograde CholangioPancreatography (ERCP) and Intraductal Secretin Test (IDST) in the Diagnosis of Chronic Pancreatitis (CP)

Background: 
 CP may be difficult to diagnose in the early stages when imaging may be normal. An IDST performed at ERCP may further evaluate for CP, with determination of pure pancreatic juice (PPJ) volume and bicarbonate concentration (BC). The optimal collection time for IDST is unknown. We report our experience with the IDST in 447 patients with suspected CP. 
 Experimental Design: 
 IDSTs performed from 2006-2018 were reviewed, with fluid collected at 5-min intervals for 20-60 minutes. Parameters evaluated were PPJ volume, Secretory Flow Rate (SFR), time of peak SFR, maximum BC and time to maximum BC. 
 Results: 
 Maximum BC was reached by 10-min in 59 patients (13.2%); 15-min: 207 patients (46.3%); 20 min: 340 patients (76.1%); 25-min: 384 patients (85.9%); 30-min: 421 patients (94.1%). Peak SFR was reached by 10-min in 92 patients (20.6%); 15-min: 177 patients (39.6%); 20-min: 240 patients (53.7%); 25-min: 284 patients (63.5%); 30-min: 323 patients (72.3%). Final diagnosis (normal vs. CP) for both SFR and BC was determined by 20-min (i.e. in CP pts, either the SFR or BC was low (SFR <3ml/min, BC <105mEq/L) and remained low throughout collection, or normal (>3ml/min and >105mEq/L) within the first 20-min. Further collection did not change the diagnosis. 
 Conclusion: 
 At IDST, a 20-minute collection period is necessary to categorize patients into normal or suspected CP groups. A study in control patients (no suspicion of CP) to validate these data is currently underway.

Effects of poorly hydrolizable ingredients in mixed feeds on pancreatic exocrine function in chickens

The response of the pancreas to the use of the poorly hydrolysable ingredients (wheat bran and sunflower meal) in the mixed feed diet was shown under the conditions of the chronic experiments on chickens. The proteolytic enzyme activity decreases by 22–36% as compared to the control because of a 10% decrease in the dietary crude protein level. The lipase activity increases by 17–26% due to an increase in the dietary crude fat content, while the amylase activity remains significantly unchanged with an increase in the dietary amount of nonstarch polysaccharides. The process of the pancreatic adaptation to the new dietary feed generally occurs through a change in the activity of pancreatic enzymes rather than the volume of pancreatic juice. This can indicate the fine adjustment of the digestive system to any change in feed quality.

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis.

To determine if T1-weighted MR signal of the pancreas can be used to detect early CP. A retrospective analysis was performed on 51 suspected CP patients, who had both secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) and an intraductal secretin stimulation test (IDST). There were 29 patients in normal and 22 patients in the low bicarbonate group. Bicarbonate level, total pancreatic juice volume, and excretory flow rate were recorded during IDST. Signal intensity ratio of pancreas (SIR), fat signal fraction, pancreatograms findings, and grade of duodenal filling were recorded on S-MRCP by two blinded radiologists. There was a significant difference in the signal intensity ratio of the pancreas to spleen (SIRp/s) between the normal and low bicarbonate groups (p<0.0001). A significant positive correlation was found between pancreatic fluid bicarbonate level and SIRp/s (p<0.0001). SIRp/s of 1.2 yielded sensitivity of 77% and specificity of 83% for detection of pancreatic exocrine dysfunction (AUC: 0.89). T1-weighted MR signal of the pancreas has a high sensitivity and specificity for the detection of parenchymal abnormalities related to exocrine dysfunction and can therefore be helpful in evaluation of suspected early CP.

Estimated pancreatic parenchymal remnant volume accurately predicts clinically relevant pancreatic fistula after pancreatoduodenectomy

Postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) leads to prolonged hospitalization and potentially fatal complications. We sought to determine whether estimated pancreatic parenchymal remnant volume (EPPRV) on preoperative computed tomography (CT) predicts clinically relevant POPF. This retrospective study included 246 patients who underwent PD between 2008 and 2013. Pancreatic thickness, pancreatic width, and main pancreatic duct (MPD) diameter at the estimated transection line in addition to estimated whole pancreatic remnant volume (EWPRV) were measured on preoperative CT images. MPD volume was subtracted from EWPRV to determine EPPRV. The predictive ability of preoperative CT parameters for POPF was evaluated. EPPRV was an independent predictor of POPF and had a stronger association with POPF than EWPRV. Receiver operating characteristic curve analysis showed that EPPRV had the greatest area under the curve (0.885) for predicting POPF. EPPRV ≥25.5cm(3) was the best cutoff value for predicting POPF, with a high negative predictive value (0.934) and low likelihood ratio of a negative result (0.235). Multivariate analysis including the preoperative CT parameters and well-known risk factors for POPF showed that EPPRV ≥25.5cm(3) had the greatest odds ratio for POPF. EPPRV was correlated with pancreatic juice volume. Patients with EPPRV ≥25.5cm(3) had a greater drainage fluid amylase concentration and greater duration of drainage tube placement than those with EPPRV <25.5cm(3). EPPRV from preoperative CT was highly predictive of POPF and may help in development of management for POPF after PD.

Assessment of exocrine pancreatic function by secretin‐stimulated magnetic resonance cholangiopancreaticography and diffusion‐weighted imaging in healthy controls

To characterize and quantify exocrine pancreatic function by secretin-stimulated magnetic resonance cholangiopancreaticography (s-MRCP) and diffusion-weighted imaging (DWI) in healthy subjects and compare these findings to morphological features, ie, pancreatic volume and secretin-stimulated peak bicarbonate concentration measured in pancreatic juice. Pancreatic magnetic resonance imaging (MRI) (1.5 T) was performed in 20 healthy volunteers among which 10 underwent gastroscopy with duodenal intubation. MRI included T2-weighted imaging and DWI acquired before and 1, 5, 9, and 13 minutes after secretin administration. Secreted pancreatic juice volumes were calculated based on the sequential T2-weighted images and pancreatic volumes and apparent diffusion coefficient (ADC) values were estimated. The mean pancreatic secretion rate declined from 9.5 mL/min at 1-5 minutes (postsecretin) to 2.9 mL/min at 9-13 minutes. Pancreatic head ADC values significantly increased from baseline (1.29 × 10(-3) mm(2) /s) to 1 minute postsecretin (1.48 × 10(-3) mm(2) /s) (P = 0.003). Secreted pancreatic juice volume at 1 minute after secretin correlated positively with peak bicarbonate concentration (n = 10, P = 0.05). Secretin-stimulated MRCP and DWI can characterize and quantify exocrine pancreatic function in healthy subjects. These imaging methods may prove relevant for patients with exocrine pancreatic dysfunction.

The Significance of the Volume of Pancreatic Juice Measured at Secretin Stimulation Testing

(1) To quantitate volume production during secretin stimulation testing in patients suspected of having chronic pancreatitis (CP); (2) to compare volume production to clinical criteria for the diagnosis of CP. A total of 224 patients referred for suspected CP were reviewed retrospectively for clinical information supporting the diagnosis of CP. The patients were divided into 2 groups: those with peak bicarbonate (PB) of less than 80 mEq/L and those with PB of 80 mEq/L or greater (ie, CP and no CP). For a separate comparison, the patients were also placed into similar 2 groups based on clinical criteria. The volume, total bicarbonate output, volume per kilogram, and PB of pancreatic juice after secretin stimulation in patients thought to have CP were compared to those thought not to have CP. Volume was lower in the patients with PB of less than 80 mEq/L (206 ± 114 and 269 ± 106 mL) and lower in patients who met clinical criteria for CP (203 ± 109 and 271 ± 108 mL), P < 0.001 for both, but there was significant overlap (volume alone did not accurately discriminate CP from no CP). During secretin stimulation testing, bicarbonate parameters likely are better predictors of CP than volume parameters. Changes in the production of the volume of pancreatic juice during secretin stimulation likely reflect relatively late changes in pancreatic function.

Valsartan, a specific angiotensin II receptor blocker, inhibits pancreatic fluid secretion via vagal afferent pathway in conscious rats

Background/aimThe renin–angiotensin system (RAS) exists in the pancreas, but the role of RAS in the regulation of pancreatic exocrine secretion under physiological conditions has been little known. The present study addressed the RAS's effect on the pancreatic secretion by using valsartan, a specific angiotensin II receptor blocker, in conscious rats. MethodMale Wistar rats prepared with pancreatic, biliary, duodenal and jugular vein cannulas were used. To examine the role of RAS in the pancreatic secretion, valsartan at 1, 5, or 25mg/kg was administered into the duodenum via cannula, and volume of pancreatic juice and protein concentration were determined. In addition, to examine the role of RAS in hormone-stimulated pancreatic hypersecretion, pancreatic secretion was examined in response to stimulation of secretin or cholecystokinin after intraduodenal infusion of valsartan at 25mg/kg. Furthermore, to examine the mechanism of action of RAS on pancreatic secretion, intravenous infusion of atropine or perivagal application of capsaicin was conducted and then the pancreatic secretion was examined following intraduodenal infusion of valsartan at 25mg/kg. ResultsVolume of pancreatic juice, but not protein output, significantly decreased after administration of valsartan. However, administration of valsartan did not exert significant effects on secretin- or cholesystokinin-stimulated pancreatic secretion. Treatment with atropine and perivagal application of capsaicin completely abolished the suppressive effect of valsartan on pancreatic juice secretion. ConclusionPresent results suggest that RAS plays a stimulatory role in pancreatic juice secretion via cholinergic afferent pathway without affecting protein secretion and hormonally stimulated pancreatic secretion under physiological conditions.

Regulation of pancreatic exocrine secretion in goats: differential effects of short‐ and long‐term duodenal phenylalanine treatment

Four yearling goats (31.2 ± 2.5 kg), surgically fitted with common bile duct reentrant and duodenal catheter, were used in two 4 × 4 Latin square design experiments to investigate the effects of duodenal infusion of phenylalanine for different times on pancreatic exocrine secretion (PES). In experiment 1 (the long-term experiment), goats were duodenally infused with 0, 2, 4 or 8 g/day phenylalanine for 14 day. Pancreatic juice and jugular blood samples were collected over 1-h intervals for 6 h daily from day 11 to day 14 to encompass a 24-h day. In experiment 2 (the short-term experiment), goats were infused with phenylalanine for 10 h continuously at the same infusion rate as experiment 1 after feed deprivation for 24 h repeated every 10 day. Pancreatic juice and blood samples were collected at 0, 1, 2, 4, 6, 8 and 10 h of infusion. The volume and pH of pancreatic juice were measured, and a 5% subsample was composited and frozen until analysis of enzyme activities. Plasma was frozen until analysis of insulin and cholecystokinin (CCK). In experiment 1, pancreatic juice, α-amylase secretion and plasma CCK concentration responded quadratically (p < 0.05), with the top value observed at the 2 g/day phenylalanine. Trypsin secretion had a quadratic response (p < 0.05), with secretion increasing up to 4 g/day phenylalanine and decreasing thereafter. Phenylalanine linearly decreased pancreatic protein and lipase secretion (p < 0.05). The results of correlation analysis showed significant correlations (p < 0.05) between plasma CCK concentration and secretion of α-amylase and trypsin. However, the short-term phenylalanine infusion did not influence (p > 0.05) pancreatic juice, protein, α-amylase, lipase, trypsin secretion and plasma CCK concentration. These results indicate PES of ruminants is stimulated by phenylalanine and is potentially mediated by CCK in the long-term duodenal infusion treatment, but is not influenced by phenylalanine in the short-term duodenal infusion treatment.

A note on modification of pancreatic juice and bile collection method in sheep

The aim of the study was to modify and evaluate the method of management of pancreatic juice and bile secretions in sheep in chronic experiment. Experiment was performed on 12 adult male Corriedale sheep of 54 ± 2.4 kg body weight, fi tted with two biomedical silicone catheters in the common bile duct according to the method described by Kato and Young (Kato et al., 1999) and our modifi cation duodenal cannula. Duodenal cannula was equipped with silicone valve in the basement part to prevent secretions backfl ow. Except the collection time, animals were freely moving in the individual pens and all secretions were returned to duodenum by means of constructed device. During all experimental treatments secretion volume of pancreatic juice was from 11.7 to 34.8 ml·h -1 . Modifi cation of Kato and Young method allows extending the period of animals use even up to more than 6 months. Moreover, it positively impacts animals welfare by reducing time spending in the metabolic cages, and saves labour expenses.

Reduced inhibitory effect of somatostatin on the exocrine function of the pancreas and on serum insulin (IRI) levels in chronic relapsing pancreatitis.

In 3 healthy men and 4 healthy women, and in 5 men and 2 women with confirmed chronic relapsing pancreatitis (CRP) the inhibitory effect of somatostatin cn pancreatic exocrine function and insulin secretion stimulated with pancreozymin and secretin was determined. In all 7 patients with CRP the volume of pancreatic juice and the bicarbonate and amylase and protein output after stimulation were lower than in healthy subjects, and somatostatin had a reduced inhibitory effect on both the basal secretion and particularly on the pancreozymin-secretin-stimulated secretion. A similarly lower inhibitory effect of somatostatin on the secretin-pancreozymin induced increase in blood insulin (IRI) level was observed in these patients. The presented data suggest that the damaged pancreas reacts less effectively not only to the stimuli enhancing its exocrine and endocrine secretory activity, but also to the stimuli inhibiting this activity. This observation may be of practical value for the evaluation of the functional efficiency of the pancreas.

Evaluation of Pancreatic Exocrine Secretion Using 13C-Dipeptide (Benzoyl-L-Tyrosyl-[1-13C]Alanine) Breath Test

We investigated whether a breath test using benzoyl-L-tyrosyl-[1-(13)C]alanine (Bz-Tyr-Ala) allows assessment of pancreatic exocrine function. Benzoyl-L-tyrosyl-[1-(13)C]alanine was orally administered, and changes in (13)CO2 were expressed as delta per thousand. The breath test was performed in chronic pancreatitis patients and healthy subjects in a preliminary study and, subsequently, in 17 pancreatoduodenectomy patients, to examine the difference between the results obtained at the times of pancreatic tube insertion and removal, the relationship between breath test results after tube removal and the volume of pancreatic juice drained, and the difference in results between the presence versus the absence of histological changes of chronic pancreatitis. The delta per thousand was lower in the chronic pancreatitis patients than in healthy subjects. In the postoperative patients, the delta per thousand was higher at tube insertion than at tube removal. The correlations of the delta per thousand with the maximum volume of pancreatic juice, its mean volume, and pancreatic juice amylase levels were 0.865, 0.757, and 0.853, respectively. The delta per thousand was lower in 11 patients with that in 6 patients without histological changes of chronic pancreatitis. These results suggest that the Bz-Tyr-Ala breath test can measure pancreatic exocrine function.

Attempt to establish a chronic model to study the influence of bile and pancreatic juice diversion on pancreas feedback regulation in conscious pigs

The diversion of pancreatic juice and bile stimulates pancreatic exocrine secretion but the mechanism behind this process is still not clear. The present study investigates the influence of long lasting (10 h) bile diversion or pancreatic juice and bile diversion on the pancreatic secretion in conscious pigs. The experiments were performed on 4 weaned piglets, which had a catheter inserted to the accessory pancreatic duct and bile duct and two cannulas to the duodenum. The depletion of bile alone or both bile and pancreatic juice (PJ) resulted in an increased preprandial pancreatic juice outflow, as compared to controls. Bile diversion increased the pancreatic response to feeding. PJ volume, protein outflow, and trypsin activity values were significantly higher in bile diverted pigs than in control pigs during the prandial and postprandial periods. While in pancreatic juice and bile diverted piglets the PJ protein outflow and trypsin activity slightly increased in response to feeding, their values were lower than those of the control piglets. In conclusion, both pancreatic juice and bile present in the small intestine play an important role in the regulation of the pancreatic juice secretion. (c) 2007 Elsevier B.V. All fights reserved. (Less)

The clinical relevance of isolated ventral pancreas.

An isolated ventral pancreas results from failure of fusion of the dorsal and ventral pancreatic ducts. Until the advent of endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of this abnormality was not known. A series of 11 such patients in 850 consecutive ERCP examinations is described. No other cause for their symptoms was discovered. Secretory studies showed a low volume of pancreatic juice with normal concentration of bicarbonate and trypsin. In 5 cases operative dorsal pancreatography was performed: it was normal in all cases. In 3 cases the pancreatic tail was amputated and found unexpectedly to be the seat of pancreatitis in 2. Isolated ventral pancreas may be associated with pancreatitis, but this is not proved.

Exogenous leptin inhibits the secretion of pancreatic juice via a duodenal CCK 1-vagal-dependent mechanism in anaesthetized rats

Leptin originally described as product of the ob gene has been shown to be expressed in various tissues including the gastrointestinal tract. In this study, we investigated the influence of leptin on the secretion of pancreatic juice in biliary–pancreatic duct cannulated anaesthetised rats and in dispersed rat pancreatic acini in vitro. Exogenous leptin was given in boluses intravenously with or without CCK-8 (12 pmol kg −1 body weight) in the presence or absence pharmacological CCK 1 receptor blockade, cervical vagotomy, and capsaicin pre-treatment. Administration of leptin (0.1, 1 and 10 μg kg −1 body weight) did not affect the volume of bile and pancreatic juice while the protein and trypsin outputs were reduced in a dose-dependent manner. In the rats, leptin inhibited CCK-8 stimulated protein and trypsin outputs stronger than the basal pancreatic secretion. The inhibition by leptin was abolished by the pharmacological CCK 1 receptor blockade, cervical vagotomy, and capsaicin pre-treatment. In contrast, leptin did not affect basal and CCK-8-stimulated amylase release from the dispersed rat pancreatic acini in vitro. In conclusion, the results of the present study suggest that leptin does not act directly on the rat pancreatic acinar cells but inhibits the secretion of pancreatic enzymes acting indirectly via a neurohormonal CCK-vagal-dependent mechanism.

Experimental Model of Obstructive, Chronic Pancreatitis in Pigs

Background: We aimed to develop a reproducible, experimental model of obstructive pancreatitis for future analysis of surgical interventions, and characterized this model using functional, histological and biochemical parameters. Animals and Methods: In 10 female pigs the pancreatic duct (PD) was ligated. After 4, 6 or 8 weeks the animals were sacrificed. Before and after ligation, glucose tolerance and intraductal pressure were measured, and pancreatic juice was collected after stimulation with cholecystokinin and secretin. Amylase and lipase activities were analyzed in plasma and juice. Pancreatic tissue was collected for histochemical analysis. Results: Within 4 weeks of ligation, the pancreas appeared atrophic. Intraductal pressure had risen significantly. Acinar-to-ductal metaplasia was accompanied by strong proliferation of stellate cells and increased collagen deposition. Islets of Langerhans appeared smaller and more numerous. Blood amylase and lipase levels were normal and glucose tolerance was unaffected. Pancreatic juice volume and amylase and lipase activities were significantly lower. Conclusion: Ligation of the PD in pigs resulted in a marked fibrosing obstructive pancreatitis within 4 weeks, similar to human chronic pancreatitis in regard to clinical, functional, histological and biochemical parameters.

Exocrine Pancreatic Secretion Is Stimulated in Piglets Fed Fish Oil Compared with Those Fed Coconut Oil or Lard

An experiment was conducted to study the effect of feeding diets containing fat sources with different fatty acid composition (fish oil, coconut oil or lard, 10 g/100 g diet) on exocrine pancreatic secretion in piglets after weaning. A total of 16 barrows were weaned at 4 wk of age; 3 d later, they were surgically fitted with a catheter in the pancreatic duct for continuous collection of pancreatic juice. Collections of pancreatic juice were made every other day starting 4 d postsurgically. Piglets fed the fish oil diet secreted a significantly greater volume of pancreatic juice than piglets fed the coconut oil or lard diets. The output [U/(h. kg(0.75))] of lipase was higher in piglets fed fish oil than in piglets fed lard or coconut oil. The output of colipase was greater in piglets fed fish oil and coconut oil than in those fed lard. The dietary treatments did not affect the output of carboxylester hydrolase. The output of trypsin was significantly lower in piglets fed lard than in piglets fed fish oil or coconut oil diets and the output of carboxypeptidase B was greater in those fed the fish oil diet. Protein, chymotrypsin, carboxypeptidase A, elastase and amylase outputs did not differ among the dietary treatment groups. The apparent digestibilities of nutrients and energy were measured in feces and did not differ among groups. Thus, the greater output of lipase in fish oil-fed piglets did not result in a greater digestibility of fat in this diet.

Immunoglobulin A secretion into pancreatic juice as a novel marker of local immune defense and exocrine pancreatic function.

The importance of secretory immunoglobulin A (IgA) of local immune defense in the gastrointestinal tract has gained increasing acceptance. Bacterial contamination is a major factor related to mortality in acute pancreatitis. However, very little is known about IgA in pancreatic juice. Pure pancreatic juice was collected from 40 patients undergoing pancreatoduodenectomy. The patients were divided into three groups according to the degree of preoperative pancreatic duct obstruction, as follows: normal, narrowed, and obstructed. IgA concentration, amylase activity, and daily volume of pancreatic juice were measured. Daily IgA secretion into pancreatic juice was constant during the early period after the operation. The concentration of IgA in the control group was 5 +/- 0.8 microg/ml, and IgA daily secretion was 1.2 +/- 0.2 mg/day. Pancreatic duct obstruction resulted in a marked decrease in both amylase and pancreatic juice secretion. The concentration of IgA, however, was markedly increased in the narrowed group (11.1 +/- 2.4 microg/ml) and the obstructed group (32.5 +/- 5.4 microg/ml). The concentration of amylase increased with the increase in pancreatic juice. Conversely, the concentration of IgA increased with the decrease in volume of pancreatic juice. Similarly, the increased in IgA concentrations positively correlated with the decrease in amylase activity. In conclusion, the mechanisms that modulate IgA secretion in the human pancreas are essentially different from those that modulate digestive enzyme and fluid secretion. IgA in pancreatic juice may play an important role in pathological conditions such as pancreatic duct obstruction. As such, the measurement of IgA in pancreatic juice may potentially be used as a new marker of local immune defense and exocrine pancreatic function.