Motilin: a panoply of communications between the gut, brain, and pancreas.

Introduction: Motilin was first alluded to nearly a century ago. But it remains a rather abstruse peptide, in the shadow of its younger but more lucid 'cousin' ghrelin.Areas covered: The review aimed to bring to the fore multifarious aspects of motilin research with a view to aiding prioritization of future studies on this gastrointestinal peptide.Expert opinion: Growing evidence indicates that rodents (mice, rats, guinea pigs) do not have functional motilin system and, hence, studies in these species are likely to have a minimal translational impact. Both the active peptide and motilin receptor were initially localized to the upper gastrointestinal tract only but more recently - also to the brain (in both humans and other mammals with functional motilin system). Motilin is now indisputably implicated in interdigestive contractile activity of the gastrointestinal tract (in particular, gastric phase III of the migrating motor complex). Beyond this role, evidence is building that there is a cross-talk between motilin system and the brain-pancreas axis, suggesting that motilin exerts not only contractile but also orexigenic and insulin secretagogue actions.

Elevated Circulating Levels of Motilin are Associated with Diabetes in Individuals after Acute Pancreatitis.

AIM: The study aimed to investigate the associations between glycaemic control after acute pancreatitis and gastrointestinal motility, using plasma motilin concentration and gastroparesis cardinal symptom index score as proxies. METHODS: This cross-sectional study recruited a total of 93 individuals after acute pancreatitis. Gastroparesis cardinal index scores, demographic and anthropometric factors, as well as pancreatitis-related factors were analysed. Fasting venous blood was collected to measure motilin, glycated haemoglobin, and fasting blood glucose. Linear regression analyses were conducted to investigate the associations between glycaemic control and gastrointestinal motility in unadjusted and adjusted models. RESULTS: Motilin was significantly higher in individuals with diabetes across all adjusted models, with the highest ß-coefficient (95% confidence interval) of 588.89 (138.50, 1039.28); P=0.010. Fasting blood glucose was significantly associated with motilin across all models, with the highest ß-coefficient (95% confidence interval) of 156.30 (55.49, 257.10); P=0.002. Glycated haemoglobin was significantly associated with motilin in one adjusted model with ß-coefficient (95% confidence interval) of 18.78 (1.53, 36.02); P=0.033. Gastroparesis cardinal symptom index was not significantly associated with any measure of glycaemic control. CONCLUSIONS: Diabetes in individuals after acute pancreatitis appears to be characterised by elevated plasma motilin but not gastroparesis cardinal symptom index. The role of motilin in this setting warrants further investigations.

Post-pancreatitis diabetes mellitus: towards understanding the role of gastrointestinal motility.

Post-pancreatitis diabetes mellitus (PPDM) is a sub-type of diabetes of the exocrine pancreas that develops after acute or chronic inflammation of the pancreas. While pro-inflammatory milieu, glucose metabolism, and lipid metabolism in PPDM have been investigated, little is known about gastrointestinal function in the post-pancreatitis setting. This article overviews studies on epidemiology and impact of gastroparesis in the setting of type 1 and type 2 diabetes, with a view to estimating the possible burden of gastrointestinal dysfunction in PPDM. Further, the usefulness of quantifying gastrointestinal dysmotility is discussed. The gastroparesis cardinal symptom index has emerged as a standardized gastrointestinal dysmotility endpoint and its use in individuals after pancreatitis is justified.