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Impaired exocrine pancreatic function in diabetics with diarrhea and peripheral neuropathy

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Abstract

Exocrine pancreatic insufficiency has been observed in some diabetics with peripheral neuropathy and diarrhea. Several mechanisms may be responsible for this insufficiency: (1) pancreatic atrophy, (2) disruption of the cholinergic enteropancreatic reflexes, or (3) elevated serum levels of peptides such as glucagon and pancreatic polypeptide which are known to inhibit pancreatic exocrine secretion. To clarify the mechanism(s) involved in this exocrine pancreatic impairment, we studied 10 diabetics with diarrhea and peripheral neuropathy. Their results were compared to those of eight normal volunteers. Each subject underwent a standardized pancreatic function study which assessed nonstimulated secretion, the response to intrajejunal infusion of a mixture of amino acids, and the output following intravenous administration of secretin and cholecystokinin (CCK). In separate studies, the effect of a background infusion of bethanechol and secretin on the pancreatic response to CCK was assessed in six patients and six normal controls. Compared to normals, all diabetics exhibited a significant reduction in both enzyme and bicarbonate secretion to all stimuli. This reduction was not corrected by administering bethanechol. Plasma glucagon and pancreatic polypeptide levels in diabetics were not significantly higher than those in controls. We conclude that diabetics with diarrhea and peripheral neuropathy exhibit impairment of their exocrine pancreatic secretion and possible mechanisms for this are discussed.

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Authors and Affiliations

  1. Gastroenterology and Diabetes Sections, Department of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, California

    Hussein EL Newihi MD (International Fellow), Cornelius P. Dooley MD, MRCPI,  Carlos Saad MD (International Fellow),  Janet Staples MD, Adina Zeidler MD & Jorge E. Valenzuela MD

  2. USC School of Medicine, USA

    Hussein EL Newihi MD (International Fellow) &  Carlos Saad MD (International Fellow)

Authors
  1. Hussein EL Newihi MD
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  2. Cornelius P. Dooley MD, MRCPI
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  3. Carlos Saad MD
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  4. Janet Staples MD
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  5. Adina Zeidler MD
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  6. Jorge E. Valenzuela MD
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Additional information

Dr. Staples was a USC Medical Student during this protocol.

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Newihi, H.E., Dooley, C.P., Saad, C. et al. Impaired exocrine pancreatic function in diabetics with diarrhea and peripheral neuropathy. Digest Dis Sci 33, 705–710 (1988). https://doi.org/10.1007/BF01540434

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  • DOI: https://doi.org/10.1007/BF01540434

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