Johansson C, Schmidt D N, Hellström P M
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Pancreas. 1992;7(2):205-11. doi: 10.1097/00006676-199203000-00012.
Using a multiple-marker dilution technique to quantitate flow volumes at a jejunal sampling site 70 cm from pylorus, propulsion and absorption of a 300-ml mixed liquid test meal were compared in seven patients with exocrine pancreatic insufficiency and in ten healthy subjects. In pancreatic insufficiency, outputs of lipase and amylase were 8% of control levels. Early gastric emptying rate was similar in both groups, but emptying was completed earlier, and less gastric acid was emptied in pancreatic insufficiency. In pancreatic insufficiency, initial biliary output was larger than in controls, and transit time through the test segment was twice that of controls. During the prolonged transit time, larger amounts of glucose (but less fat) were absorbed in pancreatic insufficiency. Forty minutes after the meal, almost a third of the fatty content of the meal was propelled to lower parts of the intestine. In conclusion, pancreatic insufficiency is associated with impaired inhibitory regulation of gastric and biliary outputs after a mixed meal. The impaired digestion of nutrients in pancreatic insufficiency is partially compensated for by slowing of intestinal transit, permitting more efficient absorption. Exposure of the gut to large quantities of fat is suggested to trigger the slowing of upper intestinal transit in pancreatic insufficiency.
采用多标记稀释技术，对距幽门70厘米处空肠采样点的液体流量进行定量分析，比较了7例胰腺外分泌功能不全患者和10名健康受试者对300毫升混合液体试验餐的推进和吸收情况。胰腺功能不全患者的脂肪酶和淀粉酶分泌量仅为对照组水平的8%。两组的早期胃排空率相似，但胰腺功能不全患者的排空完成得更早，且胃酸排空量较少。胰腺功能不全患者的初始胆汁分泌量大于对照组，通过试验段的转运时间是对照组的两倍。在延长的转运时间内，胰腺功能不全患者吸收了更多的葡萄糖（但脂肪较少）。进食后40分钟，几乎三分之一的膳食脂肪成分被推进到肠道下部。总之，胰腺功能不全与混合餐后胃和胆汁分泌的抑制调节受损有关。胰腺功能不全时营养物质消化受损，部分通过肠道转运减慢得到补偿，从而实现更有效的吸收。肠道暴露于大量脂肪被认为会引发胰腺功能不全患者上消化道转运减慢。
