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Exocrine Pancreatic Function in Diabetes

  • J. Enrique Domínguez-Muñoz
  • Beatriz Cigarrán
Chapter
Part of the Clinical Gastroenterology book series (CG)

Abstract

The pancreas should be considered as a single endocrine–exocrine gland with complex insulo-acinar-ductal communications. Insulin exerts a trophic and stimulatory effect on the acinar cells, digestive enzymes secreted by the acinar cells are involved in the release of gut-incretin hormones by the enteroendocrine L-cells, and gut-incretin hormones exert a stimulatory effect on insulin release and improve insulin sensitivity. Exocrine pancreatic function is altered in patients with type 1 and type 2 diabetes. Pancreatic atrophy and infiltration of inflammatory cells within the exocrine pancreas may explain reduced pancreatic secretion in type 1 diabetes. The normal structural islet–exocrine interface is lost due to fibrosis in type 2 diabetes. As interstitial fibrosis progresses, the trophic and stimulatory effects of insulin on acinar cells may be impaired and pancreatic enzyme secretion reduced. A low pancreatic enzyme secretion may be associated with gastrointestinal symptoms, and may potentially interfere with the glycemic control in diabetes, but the impact of pancreatic exocrine disturbance in these patients is unclear, and it deserves further investigation.

Keywords

Exocrine Diabetes Maldigestion Elastase Incretin 

References

  1. 1.
    Pieler T, Chen Y. Forgotten and novel aspects in pancreas development. Biol Cell. 2006;98(2):79–88.CrossRefPubMedGoogle Scholar
  2. 2.
    Bendayan M. Pathway of insulin in pancreatic tissue on its release by the B-cell. Am J Phys. 1993;264(2 Pt 1):G187–94.Google Scholar
  3. 3.
    Williams JA, Goldfine ID. The insulin-pancreatic acinar axis. Diabetes. 1985;34(10):980–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Tasyurek HM, Altunbas HA, Balci MK, Sanlioglu S. Incretins: their physiology and application in the treatment of diabetes mellitus. Diabetes Metab Res Rev. 2014;30(5):354–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Lindkvist B, Phillips ME, Domínguez-Muñoz JE. Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: prevalence and diagnostic use. Pancreatol. 2015;15(6):589–97.CrossRefGoogle Scholar
  6. 6.
    Lindkvist B, Domínguez-Muñoz JE, Luaces-Regueira M, Castiñeiras-Alvariño M, Nieto-Garcia L, Iglesias-Garcia J. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatol. 2012;12(4):305–10.CrossRefGoogle Scholar
  7. 7.
    Domínguez-Muñoz JE. Pancreatic exocrine insufficiency: diagnosis and treatment. J Gastroenterol Hepatol. 2011;26(Suppl 2):12–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Vantrappen GR, Peeters TL, Janssens J. The secretory component of the interdigestive migrating motor complex in man. Scand J Gastroenterol. 1979;14(6):663–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Pieramico O, Dominguez-Muñoz JE, Nelson DK, Böck W, Büchler M, Malfertheiner P. Interdigestive cycling in chronic pancreatitis: altered coordination among pancreatic secretion, motility, and hormones. Gastroenterology. 1995;109(1):224–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Capurso G, Signoretti M, Archibugi L, Stigliano S, DelleFave G. Systematic review and meta-analysis: small intestinal bacterial overgrowth in chronic pancreatitis. United Eur Gastroenterol J. 2016;4(5):697–705.CrossRefGoogle Scholar
  11. 11.
    Björnsson ES, Urbanavicius V, Eliasson B, Attvall S, Smith U, Abrahamsson H. Effects of hyperglycemia on interdigestive gastrointestinal motility in humans. Scand J Gastroenterol. 1994;29(12):1096–104.CrossRefPubMedGoogle Scholar
  12. 12.
    Virally-Monod M, Tielmans D, Kevorkian JP, Bouhnik Y, Flourie B, Porokhov B, et al. Chronic diarrhoea and diabetes mellitus: prevalence of small intestinal bacterial overgrowth. Diabetes Metab. 1998;24(6):530–6.PubMedGoogle Scholar
  13. 13.
    Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(Suppl 6):1–28.Google Scholar
  14. 14.
    Anagnostides A, Chadwick VS, Selden AC, Maton PN. Sham feeding and pancreatic secretion. Evidence for direct vagal stimulation of enzyme output. Gastroenterology. 1984;87(1):109–14.PubMedGoogle Scholar
  15. 15.
    Domínguez Muñoz JE. Diagnosis of chronic pancreatitis: functional testing. Best Pract Res Clin Gastroenterol. 2010;24(3):233–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Stevens T, Conwell DL, Zuccaro G, Van Lente F, Lopez R, Purich E, et al. A prospective crossover study comparing secretin-stimulated endoscopic and Dreiling tube pancreatic function testing in patients evaluated for chronic pancreatitis. Gastrointest Endosc. 2008;67(3):458–66.CrossRefPubMedGoogle Scholar
  17. 17.
    Domínguez-Muñoz JE, Nieto L, Vilariño M, Lourido MV, Iglesias-García J. Development and diagnostic accuracy of a breath test for pancreatic exocrine insufficiency in chronic pancreatitis. Pancreas. 2016;45(2):241–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Rahier J, Goebbels RM, Henquin JC. Cellular composition of the human diabetic pancreas. Diabetologia. 1983;24(5):366–71.CrossRefPubMedGoogle Scholar
  19. 19.
    Williams AJK, Thrower SL, Sequeiros IM, Ward A, Bickerton AS, Triay JM, et al. Pancreatic volume is reduced in adult patients with recently diagnosed type 1 diabetes. J Clin Endocrinol Metab. 2012;97(11):E2109–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Altobelli E, Blasetti A, Verrotti A, Di Giandomenico V, Bonomo L, Chiarelli F. Size of pancreas in children and adolescents with type I (insulin-dependent) diabetes. J Clin Ultrasound. 1998;26(8):391–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Gilbeau JP, Poncelet V, Libon E, Derue G, Heller FR. The density, contour, and thickness of the pancreas in diabetics: CT findings in 57 patients. AJR Am J Roentgenol. 1992;159(3):527–31.CrossRefPubMedGoogle Scholar
  22. 22.
    Campbell-Thompson M, Rodriguez-Calvo T, Battaglia M. Abnormalities of the exocrine pancreas in type 1 diabetes. Curr Diab Rep. 2015;15(10):79.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Rodriguez-Calvo T, Ekwall O, Amirian N, Zapardiel-Gonzalo J, von Herrath MG. Increased immune cell infiltration of the exocrine pancreas: a possible contribution to the pathogenesis of type 1 diabetes. Diabetes. 2014;63(11):3880–90.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lankisch PG, Manthey G, Otto J, Koop H, Talaulicar M, Willms B, et al. Exocrine pancreatic function in insulin-dependent diabetes mellitus. Digestion. 1982;25(3):211–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Vacca JB, Henke WJ, Knight WA. The exocrine pancreas in diabetes mellitus. Ann Intern Med. 1964;61:242–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Frier BM, Saunders JH, Wormsley KG, Bouchier IA. Exocrine pancreatic function in juvenile-onset diabetes mellitus. Gut. 1976;17(9):685–91.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Harano Y, Kim CI, Kang M, Shichiri M, Shimizu Y, Li H, et al. External pancreatic dysfunction associated with diabetes mellitus. J Lab Clin Med. 1978;91(5):780–90.PubMedGoogle Scholar
  28. 28.
    Hardt PD, Hauenschild A, Nalop J, Marzeion AM, Jaeger C, Teichmann J, et al. High prevalence of exocrine pancreatic insufficiency in diabetes mellitus. A multicenter study screening fecal elastase 1 concentrations in 1,021 diabetic patients. Pancreatol. 2003;3(5):395–402.CrossRefGoogle Scholar
  29. 29.
    Hardt PD, Krauss A, Bretz L, Porsch-Ozcürümez M, Schnell-Kretschmer H, Mäser E, et al. Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus. Acta Diabetol. 2000;37(3):105–10.CrossRefPubMedGoogle Scholar
  30. 30.
    Keller J, Layer P, Brückel S, Jahr C, Rosien U. 13C-mixed triglyceride breath test for evaluation of pancreatic exocrine function in diabetes mellitus. Pancreas. 2014;43(6):842–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Hayden MR, Patel K, Habibi J, Gupta D, Tekwani SS, Whaley-Connell A, et al. Attenuation of endocrine-exocrine pancreatic communication in type 2 diabetes: pancreatic extracellular matrix ultrastructural abnormalities. J Cardiometab Syndr. 2008;3(4):234–43.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Bertelli E, Bendayan M. Association between endocrine pancreas and ductal system. More than an epiphenomenon of endocrine differentiation and development? J Histochem Cytochem. 2005;53(9):1071–86.CrossRefPubMedGoogle Scholar
  33. 33.
    Hayden MR, Karuparthi PR, Habibi J, Lastra G, Patel K, Wasekar C, et al. Ultrastructure of islet microcirculation, pericytes and the islet exocrine interface in the HIP rat model of diabetes. Exp Biol Med Maywood. 2008;233(9):1109–23.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Laakso M, Zilinskaite J, Hansen T, Boesgaard TW, Vänttinen M, Stancáková A, et al. Insulin sensitivity, insulin release and glucagon-like peptide-1 levels in persons with impaired fasting glucose and/or impaired glucose tolerance in the EUGENE2 study. Diabetologia. 2008;51(3):502–11.CrossRefPubMedGoogle Scholar
  35. 35.
    Bretzke G. Diabetes mellitus and exocrine pancreas function. Z Gesamte Inn Med. 1984;39(16):388–90.PubMedGoogle Scholar
  36. 36.
    el Newihi H, Dooley CP, Saad C, Staples J, Zeidler A, Valenzuela JE. Impaired exocrine pancreatic function in diabetics with diarrhea and peripheral neuropathy. Dig Dis Sci. 1988;33(6):705–10.CrossRefPubMedGoogle Scholar
  37. 37.
    Kangrga RN, Ignjatović SD, Dragašević MM, Jovičić SŽ, Majkić-Singh NT. Pancreatic elastase levels in feces as a marker of exocrine pancreatic function in patients with diabetes mellitus. Lab Med. 2016;47(2):140–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Rathmann W, Haastert B, Icks A, Giani G, Hennings S, Mitchell J, et al. Low faecal elastase 1 concentrations in type 2 diabetes mellitus. Scand J Gastroenterol. 2001;36(10):1056–61.CrossRefPubMedGoogle Scholar
  39. 39.
    Terzin V, Várkonyi T, Szabolcs A, Lengyel C, Takács T, Zsóri G, et al. Prevalence of exocrine pancreatic insufficiency in type 2 diabetes mellitus with poor glycemic control. Pancreatol. 2014;14(5):356–60.CrossRefGoogle Scholar
  40. 40.
    Rathmann W, Haastert B, Oscarsson J, Berglind N, Lindkvist B, Wareham NJ. Association of faecal elastase 1 with non-fasting triglycerides in type 2 diabetes. Pancreatol. 2016;16(4):563–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • J. Enrique Domínguez-Muñoz
    • 1
  • Beatriz Cigarrán
    • 2
  1. 1.Department of Gastroenterology and Hepatology, Health Research InstituteUniversity Hospital of Santiago de CompostelaA CoruñaSpain
  2. 2.Department of Internal MedicineUniversity Hospital of Santiago de CompostelaA CoruñaSpain

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