Effects of insulin and glucose metabolism on pancreatic exocrine function

Glucose metabolism is highly dependent on hormones secreted by the islets of Langerhans, and most notably on insulin. Moreover, the endocrine and exocrine pancreas has a complex anatomical and functional interaction. The exocrine part of the pancreas is influenced by the islet hormones mainly through an isletacinar portal system, for example, the periinsular acinar cells are larger and contain more zymogen and amylase. The insuloacinar axis is also indicated by morphological evidences. Hyperinsulinemia causes pancreatic atrophy with fat replacement of the exocrine pancreas in different species. These results indirectly show the significant role of insulin on pancreatic exocrine function. However, direct evidence is also available to highlight the key role of insulin. Both endogenous and exogenous insulin evoke increases in pancreatic enzyme synthesis and growth. Insulin is not only important in healthy conditions, but is also involved in the regenerative processes during pancreatitis. Human studies have also proved the necessity of insulin in pancreatic exocrine function. In conclusion, insulin has long term effects on the regulation of the biosynthesis of pancreatic digestive enzymes and short term effects on the stimulation of pancreatic secretion. Other peptides, such as pancreatic polypeptide, glucagon and somatostatin seem to inhibit pancreatic secretion, although more experiments are needed to clarify this hypothesis. Despite our current knowledge, many other hypotheses and questions remained unanswered concerning the effects of hormones secreted by different cells of the islets of Langerhans, therefore, it seems to be of great importance to explore the effects of these hormones on pancreatic exocrine function

Does Body Mass Index associate with the endoscopic severity of gastroesophageal reflux disease?

To evaluate the association between body mass index [BMI] and gastroesophageal reflux disease [GERD] severity in the group of patients frequently suffering from moderate severe gastroesophageal reflux symptoms, one hundred and fifty eight previously untreated patients underwent upper pan-endoscopy as indicated by typical moderate severe reflux symptoms, occurring three or more times per week. Patients' BMI values were tabulated and compared to the severity of endoscopic findings [according to Savary-Millerimodified by Siewert]. Association between reflux disease activity and BMI was analyzed by Kruskall-Wallis test, while mild and severe group were compared using Mann Whitney test. Analyzing the whole group, including the patients who had no endoscopically verified erosions [Savary-Miller 0 stage = non erosive reflux disease/NERD] association was found at the level of perceivable statistical significance [p=0.0501]. However subdividing the examined population into mild [Savary-Miller 0- 1 stage] and severc [Savary-Miller 2-4 stage] groups according to the endoscopically verified mucosal lesions of the esophagus, there was a strong significant relationship between severity of GERD and BMI [p=0.0056]. In the group of patients with moderate and severe GERD symptoms elevation of BMI can be a risk factor of increased severity of GERD particularly in those who already have erosive mucosal, lesions at the time of examination