ABSTRACT
This review describes the development and application of a novel test to determine levels of human immunoreactive trypsin, an enzyme produced solely by the pancreas, in biological fluids. Being organ-specific, the assay of immunoreactive trypsin should be an ideal marker of pancreatic function, and this is supported by the results of a number of clinical and research investigations. Use of this assay in studies of chronic pancreatitis, juvenile-onset diabetes, and cystic fibrosis has yielded much valuable data, and it is expected that further research will lead to an improved understanding of these and other conditions associated with the pancreas in health and disease.
Subject(s)
Pancreas/enzymology , Pancreatic Diseases/diagnosis , Trypsin/analysis , Cystic Fibrosis/diagnosis , Diabetes Mellitus, Type 1/diagnosis , Humans , Pancreatic Diseases/enzymology , Pancreatic Neoplasms/diagnosis , Pancreatitis/diagnosis , Radioimmunoassay/methodsSubject(s)
Liver/metabolism , Pentagastrin/metabolism , Animals , Autoradiography , Bile/analysis , Biological Assay , Carbon Radioisotopes , Chromatography, Thin Layer , Dogs , Humans , In Vitro Techniques , Rats , Tissue Extracts , Urine/analysisABSTRACT
Sixteen patients underwent proximal gastric vagotomy (highly selective vagotomy) for chronic duodenal ulceration. All were subjected to preoperative and postoperative acid secretion studies. A reduction in the secretory response to pentagastrin and abolition of the response to meat extract occurred postoperatively. Plasma gastrin levels in response to meat extract were studied by radioimmunoassay. Basal plasma gastrin levels were unaffected by vagotomy and it was found that the plasma gastrin response to meat extract was not impaired after operation if the postoperative insulin test was positive. Only if the insulin test was negative was the amount of gastrin released by meat extract reduced.
Subject(s)
Gastric Juice/metabolism , Gastrins/blood , Vagotomy , Duodenal Ulcer/surgery , Female , Humans , Insulin/pharmacology , Male , Meat , Pentagastrin/pharmacology , RadioimmunoassayABSTRACT
One hundred and fifty patients suspected of having Zollinger-Ellison syndrome were investigated. High plasma gastrin levels were found in 23 and in 16 a diagnosis of Zollinger-Ellison syndrome was confirmed. Measurement of the basal and maximal acid outputs showed that these simpler investigations have considerable value as screening tests for the selection of those patients in whom gastrin studies are indicated.
Subject(s)
Gastric Juice/metabolism , Zollinger-Ellison Syndrome/diagnosis , Gastric Juice/analysis , Gastrins/blood , Histamine , Humans , Pentagastrin , Peptic Ulcer/diagnosis , Radioimmunoassay , Secretory RateSubject(s)
Gastrins/blood , Meat , Vagotomy , Fasting , Humans , Insulin/pharmacology , RadioimmunoassayABSTRACT
Some patients with the Zollinger-Ellison syndrome appear to have hypergastrinaemia and hyperplasia of the antral G cells but no tumour. This subgroup has been classified as Zollinger-Ellison syndrome type 1. We have treated such a patient by vagotomy and antrectomy, the fasting plasma gastrin and acid secretion subsequently returning to normal.A 17-year-old male had a four-year history of duodenal ulcer. Gastric secretion tests showed acid hypersecretion. Fasting plasma gastrin was 8350 pg/ml (normal 50-170 pg/ml). At laparotomy duodenal ulceration was confirmed but no pancreatic or other tumours were found. Truncal vagotomy and antrectomy was performed with distal pancreatectomy. Immunofluorescent staining showed hyperplasia of G cells in the resected antrum but a normal pancreas and duodenum. Six months after operation he was symptom free and acid secretion was reduced by 92%. The fasting plasma gastrin at two months was <50 pg/ml. These findings suggest that type 1 Zollinger-Ellison syndrome may be a clinical entity.
Subject(s)
Zollinger-Ellison Syndrome , Adolescent , Duodenal Ulcer/surgery , Fluorescent Antibody Technique , Gastric Juice/metabolism , Gastrins/blood , Humans , Hyperplasia , Islets of Langerhans , Male , Microscopy, Electron , Pancreas/pathology , Pyloric Antrum/pathology , Pyloric Antrum/surgery , Vagotomy , Zollinger-Ellison Syndrome/diagnosis , Zollinger-Ellison Syndrome/pathology , Zollinger-Ellison Syndrome/surgeryABSTRACT
A radioimmunoassay for gastrin was set up and its sensitivity and specificity were studied. The assay was then used to investigate the plasma gastrin responses in man to a normal meal and to stimulation by insulin hypoglycaemia or by instilling meat extract into the stomach. The results showed that insulin and meat extract produced very similar plasma gastrin responses which were certainly not less than those produced by feeding. However, the acid secretory response to insulin was greater than that to meat extract. This indicated that the tests acted in different ways and both may be useful in the assessment of gastric secretion.
Subject(s)
Food , Gastric Juice/metabolism , Gastrins/blood , Insulin/pharmacology , Animals , Duodenal Ulcer/physiopathology , Gastric Mucosa/metabolism , Humans , Hypoglycemia , Iodine Isotopes , Meat , Rabbits/immunology , RadioimmunoassaySubject(s)
Gastric Juice/metabolism , Gastrins/blood , Zollinger-Ellison Syndrome/diagnosis , Dyspepsia , Humans , Peptic Ulcer , Radioimmunoassay , RecurrenceABSTRACT
This is the first case report of the Zollinger-Ellison syndrome due to an infiltrating tumour of the stomach. Plasma gastrin levels were high and gastrin was demonstrated in argyrophil tumour cells by an immunofluorescent technique. Evidence is presented that the tumour arose from the G cells.
Subject(s)
Stomach Neoplasms/complications , Zollinger-Ellison Syndrome/etiology , Aged , Fluorescent Antibody Technique , Gastric Mucosa/metabolism , Gastrins/blood , Gastrins/metabolism , Humans , Male , Stomach/pathology , Stomach Neoplasms/pathology , Stomach Neoplasms/physiopathology , Zollinger-Ellison Syndrome/pathologySubject(s)
Gastrins/blood , Arteries , Biological Assay , Gastrins/metabolism , Radioimmunoassay , VeinsSubject(s)
Food , Gastrins/metabolism , Insulin/pharmacology , Meat , Gastric Acidity Determination , Gastrins/blood , RadioimmunoassayABSTRACT
Pentagastrin is rapidly removed from the circulation of the dog. It is excreted by the liver into the bile, largely in an inactivated form. Preliminary results indicate that it meets the same fate in man.
Subject(s)
Peptides/metabolism , Animals , Autoradiography , Bile/metabolism , Biological Assay , Carbon Isotopes , Dogs , Extracellular Space/metabolism , Hepatic Veins , Humans , Injections, Intravenous , Liver/metabolism , Peptides/blood , Peptides/urine , Portal Vein , RatsABSTRACT
Experiments on dogs and rats showed that synthetic human gastrin I was inactivated in the small bowel but not in the liver, whereas pentagastrin was rapidly inactivated by the liver. Similar results were obtained with tissue homogenates. The significance of these results is discussed in relation to the probably increased incidence of peptic ulceration following extensive small-bowel resection in man.
