Impaired gastric myoelectricity in patients with chronic pancreatitis: Role of maldigestion

AIM: To investigate whether gastric myoelectrical activity was impaired in patients with chronic pancreatitis (CP) and to explore the role of pancreatic enzyme in regulating gastric myoelectrical activity. METHODS: Twenty CP patients and 20 controls participated in the study. Gastric myoelectrical activity was recorded by a homemade electrogastrography (EGG) device. Two experiments were carried out. In experiment one, EGG was recorded in both controls and CP patients. While in experiment two, either pancreatic enzymes or placebo was given together with test meals. Spectral analysis was used to generate various EGG parameters. RESULTS: The control subjects, but not the CP patients, showed typically increased postprandial dominant frequency. The postprandial dominant power (DP) increment (2.24±1.13 vs 5.35±0.96 dB, P= 0.04) and the percentage of normal 2-4 cpm slow waves (63.0±3.8% vs 77.4±3.1%, P<0.05) were lower in CP patients when compared with the control. In the 20 CP patients, the DP increment (4.76±1.02 vs 2.53±1.20 dB, P<0.05) and the postprandial percentage of normal 2-4 cpm (74.4±2.8% vs 64.8±5.7%, P<0.05) were significantly higher with pancreatic enzyme replacement than the placebo. CONCLUSION: CP patients have an abnormal postprandial stomach myoelectricity showing poor response in dominant frequency/power and regularity, whereas these abnormalities are corrected after pancreatic enzyme replacement. Maldigestion is likely to be the factor leading to abnormal postprandial gastric myoelectricity of CP patients.

Decreased serum essential and aromatic amino acids in patients with chronic pancreatitis

AIM:To investigate the influence of chronic pancreatitis(CP) on serum concentrations of amino acids.METHODS:Thirty-five male patients with alcoholic CP and 21 healthy male subjects were examined.Serum concentrations of amino acids were assayed by ionpair high-performance liquid chromatography with mass detection.RESULTS:Serum glutamate concentration was increased in CP patients as compared to controls.In contrast,serum concentrations of glutamine,histidine,tyrosine,proline,tryptophan and threonine were significantly decreased in CP patients.A trend towards decreasing concentrations of serum lysine,alanine,methionine and valine as well as for total serum amino acids was observed.The sum of aromatic and the sum of essential amino acid concentrations were significantly lower in CP patients than in controls.CONCLUSION:CP leads to decreased serum concentrations of several amino acids,such as essential and aromatic serum amino acids,most likely due to decreased exocrine function.

Optimizing management of patients with pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency(PEI)is related to decreased pancreatic enzyme availability and/or activity(1).Multiples underlying mechanisms can cause PEI,such as loss of functioning parenchyma(chronic pancreatitis,pancreatic resections,pancreatic cancer...),decreased secretion despite intact parenchyma(obstruction of the pancreatic duct,decreased endogenous stimulation,intraduodenal inactivation of pancreatic secretions),and asynchrony(gastric resections,Roux-en-Y gastric by-pass)(1).