Increased interdigestive pancreatic trypsin secretion in alcoholic pancreatic disease

Abstract

Previous studies have suggested that chronic alcohol consumption in man is associated with an increased secretion of pancreatic enzymes. Precise quantitation of the output of protein and trypsin in the interdigestive state has not been possible because of large variations and small volume of pancreatic juice. We utilized a multilumen, markerperfused duodenal catheter to simultaneously monitor intraluminal pressures and collect mixed duodenal juice at the ligament of Treitz in five groups of patients: normal volunteers (group I), alcoholics without pancreatitis (group II), alcoholics who had recovered from acute pancreatitis (group III), alcoholics with chronic pancreatitis (group IV), and nonalcoholics who had recovered from acute pancreatitis secondary to biliary tract disease (group V). The output of trypsin and protein during 30 min of phase II and 60 min of CCK-OP 40 ng/kg/hr was determined in each group. The output of trypsin during phase II was 1.3±1.2 and 3.0±2.5 mg/kg/hr in groups II and III, respectively, compared to 0±0.1 in group IV (normal=0.6±0.5). The outputs in group V were similar to normals. The output of protein during the interdigestive state was 15.7±13.7 mg/min in group III, compared to 4.5±3.6 in normals (group I). The duodenal contraction rate was 4.6±3.0 and 3.3±2.7 contractions/min in groups III and II, respectively (significantly greater than the normal rate of 2.2±1.5). The pancreatic response to CCK-OP 40 ng/kg/hr was similar in all groups except group IV which had a decreased output of trypsin and protein (0.1±0.2 mg/kg/hr and 2.2±0.9 mg/min compared to group I: 3.4 mg/kg/hr and 7.7±1.9 mg/min). In summary, alcoholics and alcoholics who had recovered from acute pancreatitis were found to have a greater output of trypsin and a greater phase II duodenal contraction rate in the interdigestive state.