Relationship between diseases of the pancreas and hyperplasia of Brunner's glands.

Examination of 105 duodeno-pancreatectomy specimens showed that 75% of the cases of chronic pancreatitis (n = 74) manifested diffuse hyperplasia of Brunner's glands. In pancreatitis involving part of the pancreas in the presence of ducts of the embryonic type (n = 6), in segmental pancreatitis (n = 16), and in pancreatic cancer (n = 23), no significant difference in the thickness of the layer of Brunner's glands was found as compared with normal specimens. There was no statistically significant correlation between the degree of hyperplasia of Brunner's glands and the degree of scarring of the exocrine pancreatic parenchyma. Nor was there any correlation between existence and extent of scarring of the duodenal wall, inflammatory infiltration of the duodenal mucosa, duration of disease, consumption of alcohol and history of gall stones and ulcers in patients with and without hyperplasia of Brunner's glands. Diffuse hyperplasia of the duodenal glands is probably an adaptive reaction to the exocrine insufficiency of the pancreas or the changes in gastric function (hyperacidity, accelerated emptying of the stomach) caused by chronic pancreatitis. A fact which supports this statement is that the inhibitor hormone urogastrone--an inhibitor of gastric acid secretion--is formed in Brunner's glands. The question is also discussed whether chronic pancreatitis and hyperplasia of Brunner's glands might not also develop simultaneously in the presence of disturbances of the gastrointestinal hormones, themselves either primary or due to alcohol consumption.