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Wiener Medizinische Wochenschrift
Erschienen in:

01.02.2014 | main topic

An update on pancreatic pathophysiology (Do we have to rewrite pancreatic pathophysiology?)

verfasst von: Univ. Prof. Dr. Heinz F. Hammer

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 3-4/2014

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Summary

This review focuses on seven aspects of physiology and pathophysiology of the exocrine pancreas that have been intensively discussed and studied within the past few years: (1) the role of neurohormonal mechanisms like melatonin, leptin, or ghrelin in the stimulation of pancreatic enzyme secretion; (2) the initiation processes of acute pancreatitis, like fusion of zymogen granules with lysosomes leading to intracellular activation of trypsinogen by the lysosomal enzyme cathepsin B, or autoactivation of trypsinogen; (3) the role of genes in the pathogenesis of acute pancreatitis; (4) the role of alcohol and constituents of alcoholic beverages in the pathogenesis of acute pancreatitis; (5) the role of pancreatic hypertension, neuropathy, and central mechanisms for the pathogenesis of pain in chronic pancreatitis; (6) the relation between exocrine pancreatic function and diabetes mellitus; and (7) pathophysiology, diagnosis and treatment of pancreatic steatorrhea.
Vorheriger Artikel A case of obstructive jaundice due to autoimmune pancreatitis and a review of the literature
Nächster Artikel Pancreatic pain
Literatur
1.
Jaworek J, Nawrot-Porabka K, Leja-Szpak A, Konturek SJ. Brain-gut axis in the modulation of pancreatic enzyme secretion. J Physiol Pharmacol. 2010;61:523–31.PubMed
2.
Rehfeld JF, Friis-Hansen L, Goetze JP, Hansen TV. The biology of cholecystokinin and gastrin peptides. Curr Top Med Chem. 2007;7:1154–65.PubMedCrossRef
3.
Mössner J. New advances in cell physiology and pathophysiology of the exocrine pancreas. Dig Dis. 2010;28:722–8.PubMedCrossRef
4.
Morisset J. Negative control of human pancreatic secretion: physiological mechanisms and factors. Pancreas. 2008;37:1–12.PubMedCrossRef
5.
Love JA, Yi E, Smith TG. Autonomic pathways regulating pancreatic exocrine secretion. Auton Neurosci. 2007;133:19–39.PubMedCrossRef
6.
Gaisano HY, Gorelick FS. New insights into the mechanisms of pancreatitis. Gastroenterology. 2009;136:2040–4.PubMedCrossRef
7.
Sherwood MW, Prior IA, Voronina SG, Barrow SL, Woodsmith JD, Gerasimenko OV, Petersen OH, Tepikin AV. Activation of trypsinogen in large endocytic vacuoles of pancreatic acinar cells. Proc Natl Acad Sci USA. 2007;104:5674–9.PubMedCentralPubMedCrossRef
8.
Norman J. The role of cytokines in the pathogenesis of acute pancreatitis. Am J Surg. 1998;175:76–83.PubMedCrossRef
9.
Gloor B, Reber HA. Effects of cytokines and other inflammatory mediators on human acute pancreatitis. J Int Care Med. 1998;13:305–12.CrossRef
10.
Tenner S, Sica G, Hughes M, Noordhoek E, Feng S, Zinner M, Banks PA. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology. 1997;113:899–903.PubMedCrossRef
11.
Beger HG, Bittner R, Block S, Büchler M. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology. 1986;91:433–8.PubMed
12.
Beger HG, Rau B, Mayer J, Pralle U. Natural course of acute pancreatitis. World J Surg. 1997;21:130–5.PubMedCrossRef
13.
Bassi C, Falconi M, Girelli R, Nifosi F, Elio A, Martini N, Pederzoli P. Microbiological findings in severe pancreatitis. Surg Res Commun. 1989;5:1–4.
14.
Tonsi AF, Bacchion M, Crippa S, Malleo G, Bassi C. Acute pancreatitis at the beginning of the 21st century: the state of the art. World J Gastroenterol. 2009;15:2945–59.PubMedCentralPubMedCrossRef
15.
Mooren FC, Hlouschek V, Finkes T, Turi S, Weber IA, Singh J, Domschke W, Schnekenburger J, Krüger B, Lerch MM. Early changes in pancreatic acinar cell calcium signaling after pancreatic duct obstruction. J Biol Chem. 2003;278:9361–9.PubMedCrossRef
16.
Chaudhuri A, Kolodecik TR, Gorelick FS. Effects of increased intracellular cAMP on carbachol-stimulated zymogen activation, secretion, and injury in the pancreatic acinar cell. Am J Physiol Gastrointest Liver Physiol. 2005;288:G235–43.
17.
Mössner J. Update lecture: benign diseases of the exocrine pancreas. Dig Dis. 2011;29(Suppl. 1):9–16.PubMedCrossRef
18.
Petrov MS, Shanbhag S, Chakraborty M, Phillips AR, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology. 2010;139:813–20.PubMedCrossRef
19.
Teich N, Mössner J. Hereditary chronic pancreatitis. Best Pract Res Clin Gastroenterol. 2008;2:115–30.CrossRef
20.
Whitcomb DC, Gorry MC, Preston RA, Furey W, Sossenheimer MJ, Ulrich CD, Martin SP, Gates LK Jr, Amann ST, Toskes PP, Liddle R, McGrath K, Uomo G, Post JC, Ehrlich GD. Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet. 1996;14:141–5.PubMedCrossRef
21.
Sharer N, Schwarz M, Malone G, Howarth A, Painter J, Super M, Braganza J. Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med. 1998;339:645–52.PubMedCrossRef
22.
Cohn JA, Friedman KJ, Noone PG, Knowles MR, Silverman LM, Jowell PS. Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med. 1998;339:653–8.PubMedCrossRef
23.
Witt H, Luck W, Hennies HC, Classen M, Kage A, Lass U, Landt O, Becker M. Mutations in the gene encoding the serine protease inhibitor, Kazal type 1 are associated with chronic pancreatitis. Nat Genet. 2000;25:213–6.PubMedCrossRef
24.
Rosendahl J, Witt H, Szmola R, Bhatia E, Ozsvári B, Landt O, Schulz HU, Gress TM, Pfützer R, Löhr M, Kovacs P, Blüher M, Stumvoll M, Choudhuri G, Hegyi P, te Morsche RH, Drenth JP, Truninger K, Macek M Jr, Puhl G, Witt U, Schmidt H, Büning C, Ockenga J, Kage A, Groneberg DA, Nickel R, Berg T, Wiedenmann B, Bödeker H, Keim V, Mössner J, Teich N, Sahin-Tóth M. Chymotrypsin C (CTRC) variants that diminish activity or secretion are associated with chronic pancreatitis. Nat Genet. 2008;40:78–82.PubMedCentralPubMedCrossRef
25.
Spanier BW, Dijkgraaf MG, Bruno MJ. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update. Best Pract Res Clin Gastroenterol. 2008;22:45–63.PubMedCrossRef
26.
Ammann RW. The natural history of alcoholic chronic pancreatitis. Intern Med. 2001;40:368–75.PubMedCrossRef
27.
Chowdhury P, Gupta P. Pathophysiology of alcoholic pancreatitis: an overview. World J Gastroenterol. 2006;12:7421–7.PubMed
28.
Schneider A, Whitcomb DC, Singer MV. Animal models in alcoholic pancreatitis—what can we learn? Pancreatology. 2002;2:189–203.PubMedCrossRef
29.
Apte MV, Pirola RC, Wilson JS. Molecular mechanisms of alcoholic pancreatitis. Dig Dis. 2005;23:232–40.PubMedCrossRef
30.
Apte MV, Pirola RC, Wilson JS. Individual susceptibility to alcoholic pancreatitis. J Gastroenterol Hepatol. 2008;23(Suppl. 1):S63–8.PubMedCrossRef
31.
Gerloff A, Feick P, Singer MV. Pancreas—non-alcoholic constituents and their effects. Dig Dis. 2010;28:812–9.PubMedCrossRef
32.
Pezilli R, Morselli-Labate AM. Alcoholic pancreatitis: pathogenesis, incidence and treatment with special reference to the associated pain. Int J Environ Res Public Health. 2009;6:2763–82.CrossRef
33.
Vardanyan M, Rilo HL. Pathogenesis of chronic pancreatitis-induced pain. Discov Med. 2010;9:304–10.PubMed
34.
Ebbehoj N, Svendsen LB, Madsen P. Pancreatic tissue pressure: techniques and pathophysiological aspects. Scand J Gastroenterol. 1984;19:1066–8.PubMed
35.
Vestergaard H, Kruse A, Rokkjaer M, Frøbert O, Thommesen P, Funch-Jensen P. Endoscopic manometry of the sphincter of Oddi and the pancreatic and biliary ducts in patients with chronic pancreatitis. Scand J Gastroenterol. 1994;29:188–92.PubMedCrossRef
36.
Morgan DE, Smith JK, Hawkins K, Wilcox CM. Endoscopic stent therapy in advanced chronic pancreatitis: relationships between ductal changes, clinical response, and stent patency. Am J Gastroenterol. 2003;98:821–6.PubMedCrossRef
37.
Bradley EL 3rd. Long-term results of pancreatojejunostomy in patients with chronic pancreatitis. Am J Surg. 1987;153:207–13.PubMedCrossRef
38.
Keith RG, Keshavjee SH, Kerenyi NR. Neuropathology of chronic pancreatitis in humans. Can J Surg. 1985;28:207–11.PubMed
39.
Friess H, Shrikhande S, Shrikhande M, Martignoni M, Kulli C, Zimmermann A, Kappeler A, Ramesh H, Büchler M. Neural alterations in surgical stage chronic pancreatitis are independent of the underlying aetiology. Gut. 2002;50:682–6.PubMedCentralPubMedCrossRef
40.
Talukdar R, Saikia N, Singal DK, Tandon R. Chronic pancreatitis: evolving paradigms. Pancreatology. 2006;6:440–9.PubMedCrossRef
41.
Demir IE, Tieftrunk E, Maak M, Friess H, Ceyhan GO. Pain mechanisms in chronic pancreatitis: of a master and his fire. Langenbecks Arch Surg. 2011;396:151–60.PubMedCentralPubMedCrossRef
42.
Dimcevski G, Sami SA, Funch-Jensen P, Le Pera D, Valeriani M, Arendt-Nielsen L, Drewes AM. Pain in chronic pancreatitis: the role of reorganization in the central nervous system. Gastroenterology. 2007;132:1546–56.PubMedCrossRef
43.
Hardt PD, Ewald N. Exocrine pancreatic insufficiency in diabetes mellitus: a complication of diabetic neuropathy or a different type of diabetes? Exp Diabetes Res. 2011;2011:761950.PubMedCentralPubMedCrossRef
44.
Hardt P, Hammer H, Abrahamian H, Ebenbichler C, Hummel M, Matthaei S, Schnell O, Spinas G, Weitgasser R, Wiesli P, Philippe J. Diagnostik und Therapie der exokrinen Pankreasinsuffizienz bei Diabetes mellitus. Diabetes Stoffwech H. 2011;20:185–90.
45.
Vesterhus M, Raeder H, Aurlien H, Gjesdal CG, Bredrup C, Holm PI, Molven A, Bindoff R, Berstad A, Njolstad PR. Neurological features and enzyme therapy in patients with endocrine and exocrine pancreas dysfunction due to CEL mutations. Diabetes Care. 2008;9:1738–40.CrossRef
46.
Davidai G, Zakaria T, Goldstein R, Gilai A, Freier S. Hypovitaminosis E induced neuropathy in exocrine pancreatic failure. Arch Dis Childhood. 1986;61:901–3.CrossRef
47.
Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut 2005;54(Suppl VI):vi1–vi28.
48.
Hammer HF. Pancreatic exocrine insufficiency: diagnostic evaluation and replacement therapy with pancreatic enzymes. Dig Dis. 2010;28:339–43.PubMedCrossRef
49.
Hammer HF, Fine KD, Santa Ana CA, Porter JL, Schiller LR, Fordtran JS. Carbohydrate malabsorption: its measurement and its contribution to diarrhea. J Clin Invest. 1990;86:1936–44.PubMedCentralPubMedCrossRef
50.
Hammer HF, Hammer J. Diarrhea caused by carbohydrate malabsorption. Gastroenterol Clin N Am. 2012;41:611–27.CrossRef
Metadaten
Titel
An update on pancreatic pathophysiology (Do we have to rewrite pancreatic pathophysiology?)
verfasst von
Univ. Prof. Dr. Heinz F. Hammer
Publikationsdatum
01.02.2014
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 3-4/2014
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-013-0260-y

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