The function of the exocrine pancreas after exogenous and endogenous stimulation in Billroth II patients.

Maldigestion phenomena in patients subjected to a Billroth II (B II) operation are in part attributed to an atrophy of the pancreas due to inactivity. In order to investigate this, a Lagerlöf tube was introduced under endoscopic control into the afferent loop, and the function of the exocrine pancreas studied after endogenous and exogenous stimulation. During endogenous stimulation of the exocrine pancreas by means of a Lundh test meal, no significant differences in the secretory pattern of the Billroth II patients as compared with healthy test subjects were found. In contrast, during exogenous stimulation, the output of trypsin and chymotrypsin in healthy subjects was significantly greater than in the B II patients. Since, in comparison with maximal stimulation, the endogenous secretin released by the jejunal mucosa in response to the intake of food, effects only approximately 25% of the bicarbonate production and endogenous pancreozymin effects some 50% of the enzyme output, the maldigestion phenomena observed in B II patients are inpart understandable.