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Cholecystokinin in acute alcoholic and biliary pancreatitis

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Summary

Background. Recent studies have shown that cholecystokinin (CCK) agonist, cerulein can induce acute pancreatitis in animals. The role of CCK in the induction of acute pancreatitis in humans is unclear. We investigated plasma CCK levels in alcoholic and biliary pancreatitis on admission and during the episode of acute pancreatitis.

Methods. Plasma CCK concentrations were determined by a specific and sensitive radioimmunoassay using CCK antiserum (Euro-Diagnostica, Malmö, Sweden) in 35 patients with acute alcoholic pancreatitis, in 27 patients with acute biliary pancreatitis, in 34 patients with nonpancreatic acute abdominal pain, and in 43 healthy subjects. The mean time from the first symptoms to the plasma sample was 31 (±3.7) h in alcoholic pancreatitis patients and 25 (±5.1) h in biliary pancreatitis patients. We also determined CCK levels in 20 patients during the episode of acute pancreatitis. Normal fasting level of CCK is ≤1.12 pmol/L according to manufacturer.

Results. Basal plasma CCK concentrations were significantly lower both in alcoholic pancreatitis (mean ± SEM, 0.04±0.03 pmol/L, p<0.0001) and biliary pancreatitis patients (0.17±0.13 pmol/L, p<0.0001) than in nonpancreatic acute abdominal pain patients (1.23±0.32 pmol/L) or healthy subjects (1.18±0.20 pmol/L). Plasma CCK levels also remained low until the patient was well-recovering and had started oral diet.

Conclusion. Basal plasma CCK concentrations are significantly decreased in acute alcoholic and biliary pancreatitis after the first day from the beginning of the symptoms until the patient was well-recovering.

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References

  1. Adler G, Kern H, Scheele G. Experimental models and concepts in acute pancreatitis, in The Exocrine Pancreas: Biology, Pathobiology and Diseases, Go VLW, Gardner JD, and Schulte GA, eds. Raven, New York, 1986, pp. 407–421.

    Google Scholar 

  2. Blackstone MO. Acinar cell or interstitial space: where is the pancreatitis indicated? N Engl J Med 1987; 317: 319–320.

    Article  PubMed  CAS  Google Scholar 

  3. Steer M. Recent insights into the etiology and pathogenesis of acute biliary pancreatitis. AJR 1995; 164: 811–814.

    PubMed  CAS  Google Scholar 

  4. Imrie CW, Benjamin IS, Ferguson DC, McKay AJ, Mackenzie ON, Baumgart LH. A single centre double blind trial of trasylol therapy in primary acute pancreatitis. Br J Surg 1973; 65: 3377–3382.

    Google Scholar 

  5. Grace PA, Poston GJ, Williamson RCN. Biliary motility. Gut 1990; 31: 571–582.

    Article  PubMed  CAS  Google Scholar 

  6. Ryan JP. Motility of the biliary tree, in Textbook of Gastroenterology, Yamada T, ed. JB Lippincott, Philadelphia, 1991: 196–217.

    Google Scholar 

  7. Liddle RA, Goldfine ID, Rosen MS, Taplitz RA, Williams JA. Cholecystokinin bioactivity in human plasma. Molecular forms, responses to feeding, and relationship to gallbladder contraction. J Clin Invest 1985; 75: 1144–1152.

    Article  PubMed  CAS  Google Scholar 

  8. Thomson JC, Fender HR, Ramus NI, Villar HV, Rayford PL. Cholecystokinin metabolism in man and dogs. Ann Surg 1975; 182: 496–504.

    Article  Google Scholar 

  9. Steigerwalt RW, Goldfine ID, Williams JA. Characterization of cholecystokinin receptors on bovine gallbladder membranes. Am J Physiol 1984; 247: 709–714.

    Google Scholar 

  10. Saluja AK, Saito I, Saluja M. In-vivo rat pancreatic acinar cell function during supramaximal stimulation with caerulein. Am J Physiol 1985; 249: G702-G710.

    PubMed  CAS  Google Scholar 

  11. Watanabe O, Baccino FM, Steer ML, Meldolesi J. Effects of supramaximal caerulein stimulation on the ultrastructure of rat pancreas: early morphological changes during the development of experimental pancreatitis. Am J Physiol 1984; 246: G457-G467.

    PubMed  CAS  Google Scholar 

  12. Saluja AK, Hashimoto S, Saluja M, Powers RE, Meldolesi J, Steer ML. Subcellular redistribution of lysosomal enzymes during caerulein-induced pancreatitis. Am J Physiol 1987; 251: G508-G516.

    Google Scholar 

  13. Plusczyk T, Westermann S, Rathgeb D, Feifel S. Acute pancreatitis in rats: effects of sodium taurocholate, CCK-8 and Sec on pancreatic microcirculation. Am J Physiol 1997; 272: 310–320.

    Google Scholar 

  14. Niederau C, Borchard F, Luthen R, Niederau M. Early development of experimental biliary pancreatitis and its amelioration by CCK-receptor blockade. Hepatogastroenterology 1996; 43: 1442–1453.

    PubMed  CAS  Google Scholar 

  15. Taniguchi H, Yomota E, Kume E, Skikano T, Endo T, Nagasaki M. Effect of T-0632, a cholecystokinin A receptor antagonist, on experimental acute pancreatitis. Jpn J Pharmacol 1997; 73: 105–112.

    Article  PubMed  CAS  Google Scholar 

  16. Nordback I, Clemens J, Cameron J. The role of cholecystokinin in the pathogenesis of acute pancreatitis in the isolated pancreas preparation. Surgery 1991; 109: 301–306.

    PubMed  CAS  Google Scholar 

  17. Evander A, Ishe I, Lundquist I. Influence of hormonal stimulation by caerulein on acute experimental pancreatitis in the rat. Eur Surg Res 1981; 13: 257–268.

    Article  PubMed  CAS  Google Scholar 

  18. Evander A, Lundquist I, Ishe I. Influence of gastrointestinal hormones on the course of acute pancreatitis. Hepatogastroenterology 1982; 29: 161–166.

    PubMed  CAS  Google Scholar 

  19. Niederau C, Liddle RA, Ferrell LD, Grendell JH. Beneficial effects of cholecystokinin-receptor blockade and inhibition of proteolytic enzyme activity in experimental acute hemorrhagic pancreatitis in mice. Evidence for cholecystokinin as a major factor in the development of acute pancreatitis. J Clin Invest 1986; 78: 1056–1063.

    Article  PubMed  CAS  Google Scholar 

  20. Modlin IM, Bilchik AJ, Zucker KA, Adrian TE, Susman J, Graham SM. Cholecystokinin augmentation of surgical pancreatitis: benefits of receptor blockade. Arch Surg 1989; 124: 574–578.

    PubMed  CAS  Google Scholar 

  21. Larsen F, Schlarmann D, Andrus CC, Kaminski DL. The effect of CCK receptor antagonist CR 1409 on bile reflux pancreatitis in the opossum. Pancreas 1991; 6: 291–297.

    Article  PubMed  CAS  Google Scholar 

  22. Wisner JR, Renner IG. Asperlicin, a non-peptidal cholecystokinin antagonist, attenuates sodium taurocholate-induced acute pancreatitis in rats. Pancreas 1988; 3: 174–179.

    Article  PubMed  CAS  Google Scholar 

  23. Tani S, Itoh H, Koide M, Okabayashi Y, Otsuki M. Involvement of endogenous cholecystokinin in the development of acute pancreatitis induced by duodenal loop. Pancreas 1993; 8: 109–115.

    Article  PubMed  CAS  Google Scholar 

  24. Kobayashi M, Shinagawa K, Sugiura M, Nagasawa T, Akanahe M, Ahajisawa Y. Effect of KSG-504, a new CCK-A-receptor antagonist, on experimental acute pancreatitis in rats and mice. Nippon Yakurigaku Zasshi 1996; 107: 183–195.

    PubMed  CAS  Google Scholar 

  25. Räty S, Sand J, Laine S, Harmoinen A, Nordback I. Cholecystokinin in the early course of acute post-ERCP pancreatitis. J Am Coll Surg 1999; 189: 560–565.

    Article  PubMed  Google Scholar 

  26. Shirohara H, Otsuki M. Plasma cholecystokinin levels in acute pancreatitis. Pancreas 1997; 14: 249–254.

    Article  PubMed  CAS  Google Scholar 

  27. Owyang C, May D, Louie DS. Trypsin suppression of pancreatic enzyme secretion. Differential effect on cholecystokinin release and enteropancreatic reflex. Gastroenterology 1986; 91: 637–643.

    PubMed  CAS  Google Scholar 

  28. Folsch UR, Cantor P, Wilms HM, Schafmayer A, Becker HD, Creutzfeldt W. Role of cholecystokinin in the negative feedback control of pancreatic enzyme secretion in conscious rats. Gastroenterology 1987; 92: 449–458.

    PubMed  CAS  Google Scholar 

  29. Niederau C, Grendell JH. Role of cholecystokinin in the development and progression of acute pancreatitis and the potential therapeutic application of cholecystokinin receptor antagonists. Digestion 1999; 60(Suppl 1): 69–74.

    Article  PubMed  CAS  Google Scholar 

  30. Polakkainen P, Valtonen V, Paananen A, Schröder T. C-reactive protein (CRP) and serum phospholipase A2 in the assessment of the severity of acute pancreatitis. Gut 1987; 28: 764–771.

    Article  Google Scholar 

  31. Ranson JHC, Pasternack BS. Statistical methods for qualifying the severity of clinical acute pancreatitis. J Surg Res 1977; 22: 79–91.

    Article  PubMed  CAS  Google Scholar 

  32. Raucher E, Gerber M. Pancreatic amylase assay employing the synergism of two monoclonal antibodies. Clin Chem Acta 1989; 183: 41–44.

    Article  Google Scholar 

  33. Harmoinen A. Immunoassay of C-reactive protein using the Hitatchi 704E analyser. J Clin Chem Clin Biochem 1985; 23: 45–46.

    PubMed  CAS  Google Scholar 

  34. Wiener I, Inoue K, Fagan CJ, Lija P, Watson LC, Thompson JC. Release of CCK in man: correlation of blood levels with gallbladder contraction. Ann Surg 1981; 194: 321.

    Article  PubMed  CAS  Google Scholar 

  35. Sakamoto T, Fujimura M, Newman J, Zhu X-G, Greeley GH, Thompson JC. Comparison of hepatic elimination of different forms of cholecystokinin in dogs. Bioassay and radioimmunoassay comparison of cholecystokinin-sulfate and -33-sulfate. J Clin Invest 1985; 75: 280–285.

    Article  PubMed  CAS  Google Scholar 

  36. Tomita H, Miyasaka K, Jimi A, Mishima Y, Funakoshi A. Lack of effect of cholecystokinin receptor antagonist (CR 1505) on recovery of experimental pancreatitis after pancreatic duct occlusion in rats. Pancreas 1994; 9: 638–645.

    Article  PubMed  CAS  Google Scholar 

  37. Nordback I. Value of monitoring amylase activities in patients with pancreatitis. Lancet 1985; 11: 1092.

    Article  Google Scholar 

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Correspondence to Isto Nordback.

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Räty, S., Sand, J., Kemppainen, E. et al. Cholecystokinin in acute alcoholic and biliary pancreatitis. International Journal of Pancreatology 28, 51–57 (2000). https://doi.org/10.1385/IJGC:28:1:51

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  • DOI: https://doi.org/10.1385/IJGC:28:1:51

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