Practice guidelines in acute pancreatitis.

Dipeptidyl-peptidase IV/CD26 (DPP IV) is a cell-surface protease belonging to the prolyloligopeptidase family. It selectively removes the N-terminal dipeptide from peptides with proline or alanine in the second position. Apart from its catalytic activity, it interacts with several proteins, for instance, adenosine deaminase, the HIV gp120 protein, fibronectin, collagen, the chemokine receptor CXCR4, and the tyrosine phosphatase CD45. DPP IV is expressed on a specific set of T lymphocytes, where it is up-regulated after activation. It is also expressed in a variety of tissues, primarily on endothelial and epithelial cells. A soluble form is present in plasma and other body fluids. DPP IV has been proposed as a diagnostic or prognostic marker for various tumors, hematological malignancies, immunological, inflammatory, psychoneuroendocrine disorders, and viral infections. DPP IV truncates many bioactive peptides of medical importance. It plays a role in glucose homeostasis through proteolytic inactivation of...

Dipeptidyl-peptidase IV from bench to bedside: an update on structural properties, functions, and clinical aspects of the enzyme DPP IV.

Objective
To determine benefits of conservative versus surgical treatment in patients with necrotizing pancreatitis.

Acute Necrotizing Pancreatitis: Treatment Strategy According to the Status of Infection

/pdf/uk-guidelines-for-the-management-of-acute-pancreatitis-2xeu1tu8xl.pdf

UK guidelines for the management of acute pancreatitis

I. Introduction THE presence of intestinal factors regulating the function of endocrine secretion from the pancreas was first described in 1906 by Moore and colleagues (1). The idea that humoral factors secreted from the gut might act in this way arose after the recognition of “secretin” as a regulator of pancreatic secretion. Later it became evident that the hypoglycemic intestinal factor(s) is/are not “secretin” and the names “incretin” and “duodenin” were introduced in the 1920s and 1930s to describe these putative mediators (2–4). For several decades the nature of this/these factor(s) remained largely unknown (5–8) and before the first incretin hormone was chemically characterized, several other hormones produced in the gastrointestinal tract were discovered. The connection between the gastrointestinal tract and the endocrine pancreas was shown in the 1960s when insulin became measurable in plasma. In these classic studies, the insulin response to oral glucose and intravenous glucose, resulting in nea...

Cell and molecular biology of the incretin hormones glucagon-like peptide-I and glucose-dependent insulin releasing polypeptide

https://www.gastrojournal.org/article/0016-5085(93)90288-N/pdf

Gabexate mesilate in human acute pancreatitis

36 patients with chronic gastric or oesophageal peptic ulceration (including 6 with antrectomy), resistant to high-dose ranitidine treatment for at least 3 months, were successfully treated with 40-60 mg of omeprazole daily for periods between 1 and 2 years. Fasting serum gastrin levels were monitored at regular intervals during therapy and multiple gastric mucosal biopsies were taken during gastroscopy every 3-6 months. Gastrin levels increased significantly during the first 6 months of therapy from a medium level of 81.5 to 206 pg/ml, a slight decrease was seen thereafter. In 10 patients investigated before the start of the treatment and after 1 and 2 years, the volume density of argyrophilic cells in the oxyntic mucosa increased from 0.43 +/- 0.08 to 0.91 +/- 0.14% during the first year; this change was statistically significant. No further increase was observed thereafter. No such difference could be demonstrated between a larger group of 18 patients investigated before and after 1 year of treatment with omeprazole (0.806 +/- 0.1 vs. 0.93 +/- 0.08%) and between a larger group of 22 untreated patients and 17 patients treated for 17-24 months with omeprazole (0.73 +/- 0.1 vs. 0.86 +/- 0.09%). The volume density of argyrophilic cells found in 8 patients with gastrinoma amounted to 1.37 +/- 0.22%. No clusters of endocrine cells were found in omeprazole-treated patients. The D cell volume density in the antral mucosa decreased significantly during the first months of treatment, but steadily increased thereafter to reach pretreatment values after 17 months. There was no change in G cell volume density under therapy. No changes in gastrin levels or oxyntic argyrophilic cells were observed in the antrectomized patients. It is concluded that the hyperplasia of argyrophilic cells observed in some patients during long-term omeprazole treatment is mediated by hypergastrinaemia.

Long-term omeprazole treatment in man: effects on gastric endocrine cell populations.

Carcinoids and carcinoid syndrome.

Rats were tube-fed with omeprazole (40 μmol/kg body weight twice daily) for 30 and 60 days. As a result, fasting plasma gastrin levels were significantly elevated, while plasma somatostatin levels rem

Effect of Short- and Long-Term Feeding of Omeprazole on Rat Gastric Endocrine Cells

Results of the SPT and the ERCP staged for their severity were compared in 202 patients. The correlation between both investigations was significant (p < 0.001); however, ERCP showed significantly more severe changes (p = 0.04). Furthermore, we found that 129 (64%) patients had parallel SPT and ERCP results, matching in all four gradings of severity. Forty-three (21%) patients had abnormal results for both SPT and ERCP, but the severity gradings did not parallel. Finally, 30 (15%) patients showed totally nonparallel results, a normal SPT and abnormal ERCP, or vice versa. Abnormal ERCP but normal SPT results were found in 23 of these 30 patients (group 1), and normal ERCP but abnormal SPT results in the seven remaining cases (group 2). In the first group, more patients had a history of acute pancreatitis compared to the second group (19 vs. one, p < 0.005). Based on medical history, laboratory and functional test results, and other morphological tests, chronic pancreatitis was diagnosed in two of 23 patients in group 1 and in all seven patients in group 2. Follow-up interviews (86 +/- 54 months) were possible in 20 of the remaining 21 patients in group 1 and showed definite chronic pancreatitis in one and probable chronic pancreatitis in another two of them, whereas in the other 17 patients no symptoms of acute pancreatitis or abdominal pain suggestive of chronic pancreatitis had occurred. In conclusion, both SPT and ERCP should be used to complement each other when chronic pancreatitis is suspected. ERCP seems to over-diagnose the disease since duct changes may only reflect scars after severe acute pancreatitis, or old age, and are not necessarily a sign of chronic pancreatitis. SPT seems to diagnose chronic pancreatitis with more reliability.

Secretin-Pancreozymin Test (SPT) and Endoscopic Retrograde Cholangiopancreatography (ERCP): Both Are Necessary for Diagnosing or Excluding Chronic Pancreatitis

F. Stöckmann

Papers

Gabexate mesilate in human acute pancreatitis

Long-term omeprazole treatment in man: effects on gastric endocrine cell populations.

Carcinoids and carcinoid syndrome.

Effect of Short- and Long-Term Feeding of Omeprazole on Rat Gastric Endocrine Cells

Secretin-Pancreozymin Test (SPT) and Endoscopic Retrograde Cholangiopancreatography (ERCP): Both Are Necessary for Diagnosing or Excluding Chronic Pancreatitis