You are here

Article Text

Article menu
Download PDFPDF
Review
Human pancreatic exocrine response to nutrients in health and disease
  1. J Keller,
  2. P Layer
  1. Israelitic Hospital, University of Hamburg, Hamburg, Germany
  1. Correspondence to:
    Dr J Keller
    Israelitic Hospital, University of Hamburg, Orchideenstieg 14, D-22297 Hamburg, Germany; kellerik-h.de

https://doi.org/10.1136/gut.2005.065946

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    1.0 INTRODUCTION

    Optimal digestion and absorption of nutrients requires a complex interaction among motor and secretory functions of the gastrointestinal tract. Digestion of macronutrients is a prerequisite for absorption and occurs mostly via enzymatic hydrolysis. In this context, pancreatic enzymes, in particular lipase, amylase, trypsin, and chymotrypsin, play the most important role but several brush border enzymes as well as other pancreatic and extrapancreatic enzymes also participate in macronutrient digestion. The crucial importance of pancreatic exocrine function is reflected by the detrimental malabsorption in patients with untreated pancreatic exocrine insufficiency, which is a typical complication of, for example, chronic pancreatitis.1–4

    Comprehensive knowledge about the physiological pancreatic exocrine response to normal diets and to individual food components and about alterations in pancreatic exocrine insufficiency is necessary to administer a pancreatic enzyme preparation which imitates physiological conditions closely. Although many efforts have been made to substitute for pancreatic exocrine insufficiency by specially designed pancreatic enzyme preparations, these still have several disadvantages compared with physiological enzyme secretion. In particular lipid absorption is not completely normalised in most patients.5

    As a basis for a better understanding of pancreatic exocrine function in health and disease this review will first summarise literature data on pancreatic exocrine response to a normal diet and to administration of individual food components in healthy humans. The next chapter will focus on pancreatic responses to a normal diet and to administration of individual food components in patients with pancreatic diseases, in particular chronic pancreatitits, but also in patients with other pancreatic and non-pancreatic diseases which are associated with intraluminal lack of pancreatic enzymes, for instance coeliac disease and diabetes mellitus. Other evidence of pancreatic involvement and dysfunction in these diseases will also be discussed, particularly if sufficient data on endogenously stimulated pancreatic secretion are lacking.

    2.0 SECRETORY RESPONSE OF THE EXOCRINE PANCREAS TO NUTRIENTS IN HEALTHY HUMANS

    2.1 Introduction

    The healthy human pancreas adopts …

    View Full Text

    Footnotes

    • We have no other competing financial interests.

    • Competing interest statement: Commercial interests of any company producing or selling pancreatin preparations may be affected by the conclusions of this review. In the past five years both authors have received financial support for research, educational and scientific consulting activities from various pharmaceutical companies producing and selling enzyme preparations including Solvay Pharmaceuticals, Hannover, who sponsored this review by educational grant. None of the authors has been employed by an organisation that may in any way gain or lose financially from the conclusions of our review. None of the authors holds any stocks or shares in an organisation that may in any way gain or lose financially from the conclusions of our review. Both authors have given medical opinion statements on the subject of our review—that is, pancreatic exocrine insufficiency.