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The Role of Cholecystokinin and Pancreatic Exocrine Function in Patients with Dyspepsia

Author: XuHuanHai
Tutor: ZuoJianMin
School: Zhejiang University
Course: Internal Medicine
Keywords: Dyspepsia Cholecystokinin Pancreatic Exocrine Function Fecal Elastase-1
CLC: R57
Type: Master's thesis
Year: 2005
Downloads: 74
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Abstract

Dyspepsia, which is considered to denote episodic or persistent symptoms that include upper abdomen, upper discomfort, upper abdominal fullness, early satiety, bloating, or nausea. It had high prevalence of nearly 20%~40% in Western countries .Generally, dyspepsia could be divided into ’functional dyspepsia’ and ’organic dyspepsia’. In many patients with dyspepsia, clinical assessment and investigation failed to identify any abnormality to which the symptoms can reasonably be attributed. They will be called ’functional dyspepsia’ .Conversely ’organic dyspepsia’ had definite responsible causes had been identified. The etiology of FD was still undetermined, the main mechanisms include abnormal kinetics of gastrointestinal tract, abnormal sensitivity of visceral, change of gut-brain peptide , and psychological change . Some patientshad dyspeptic symptoms after laparoscopic cholecystectomy , and duodenogastric reflux was regarded as a pathogenic factor.The gut hormone cholecystokinin(CCK) regulates pancreatic eazyme synthesis and secretion, inhibits postprandial gastric emptying , and promotes gallbladder contraction , as well as stimulates bile secretion. Recent study showed that release of CCK in response to fat ingestion play a major role in the inhibition of postprandial gastric emptying by altering gastric motility and was an important factor in the generation of bloating and early satiety. A study suggests that cholecystectomy cause an exaggerated meal-stimulated CCK response, and CCK play a major role in the increased incidence of gastroesophageal reflux after cholecystectomy and the occurrence of dyspeptic symptoms .It is unclear that the exocrine pancreatic function of the patients with FD and the dyspeptic patients who had undergone cholecystectomy would be inhibited, then the digestive enzymes would decrease, and induce negative feedback of the rising of the level of CCK in plasma , consequently resulted in dyspeptic symptoms. So our study was aimed in research the exocrine pancreatic function and level of plasma CCK in the patients with FD and the dyspeptic patients who had been performed cholecystectomy, and hoped to explain the mechanism of dyspepsia.Pancreatic elastase-1 is proteolytic enzyme exclusively produced in the pancreas. It is stable during the intestinal passage and accumulated in a six-fold concentration in stool compared to the concentration in the duodenal juice. So faecal elastase 1 is avaluable new tubeless pancreatic function test.The multiple digestive enzymes capsules have been treated with dyspeptic symptoms from various origins. It is unclear that pancreatic enzymes maybe play a role in the regulation of plasma CCK secretion and exocrine pancreatic function.In the study the dyspeptic symptoms of the patients with FD and the dyspeptic patients who had undergone laparoscopic cholecystectomy were scored on a scale criterion. And plasma CCK was assayed by the way of radioimmunoassay. And Fecal elastase-1 was assayed by a ELLISA method. All patients were treated by multiple digestive enzymes capsules, then the dyspeptic symptoms were assessed again. In this study we hoped to know the changes of the level of plasma CCK and the exocrine pancreatic function, then illuminated the mechanism of dyspepsia. Also we tended to provide a suggestive thesis of the mechanism of dyspepsia treated with digestive enzymes.Subjects and Methods Subjects41 patients with dyspeptic symptoms were enrolled according to the diagnostic critiria. Group FD inculded 21 patients (13 women, 8 men; aged 20-50 years) with Rome II Diagnostic Criteria of FD . Group LC included 20 dyspeptic patients (13 women, 7 men; aged 24-58 years) who had undergone laparoscopic cholecystectomy. 10 healthy subjects (6 women, 4 men; aged 23-49 years) as controls were included in Group N.MethodsAll subjects were interviewed with questionnaire. The following symptoms were documented including upper abdomen, upper discomfort, upper abdominal fullness, early satiety, bloating, and nausea. The severity of symptoms were classified as follows: "0"

The Role of Cholecystokinin and Pancreatic Exocrine Function in Patients with Dyspepsia

Abstract

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