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Postprandial plasma secretin response in Whipple‐treated patients
Author(s) -
Takada Tadahiro,
Yasuda Hideki,
Watanabe Shinichiro,
Miyakawa Shuichi
Publication year - 1996
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/bf01212781
Subject(s) - postprandial , secretin , jejunum , medicine , gastrin , gastroenterology , whipple procedure , endocrinology , meal , gastrectomy , chemistry , pancreas , insulin , pancreaticoduodenectomy , secretion , cancer
We hypothesize that the presence of a few secretin‐releasing cells sited in the upper jejunum may provoke a postprandial secretin response to meal loading in patients who have undergone the Whipple procedure. This procedure involves gastrectomy and total duodenectomy and requires gastrointestinal tract reconstruction by one of three methods: (i) choledocho‐pancreatico‐gastro alignment (PD‐1), (ii) pancreatico‐choledocho‐gastro alignment (PD‐2) (both these methods excluding the upper jejunum from the route of food passage), or (iii) gastro‐pancreatico‐choledocho alignment (PD‐3), in which food passes through the upper jejunum. Fasting and postprandial plasma secretin and gastrin response were measured in 47 Whipple‐treated patients, 16 given a PD‐1, 15 given a PD‐2, and 16 given a PD‐3, and in 15 healthy controls. Plasma secretin response and integrated secretin release were higher, but not significantly, in the PD‐3 group, and lower in all three Whipple‐treated groups than in the control ( P <0.05). Plasma gastrin concentration showed no significant increase in any of the three treated groups and was significantly lower than in the controls ( P <0.05). The integrated gastrin release also did not differ among the treated groups and was lower than in the controls ( P <0.05). Twenty‐four‐h monitoring showed that the gastric pH was neutral or alkaline in all three treated groups. The failure to prove our hypothesis may be due to the presence of too few secretin‐releasing cells in the upper jejunum to respond to the meal loading and/or to the intragastric pH not being sufficiently acidic to stimulate those secretin‐releasing cells present in the upper jejunum.