[Gut hormone secreting cells--unsolved problems].

The gut endocrine cells generally are bipolar paraneurons, extending from the epithelial base to the luminal surface. The cells, also known as the basal-granulated cells, produce peptidic and amine ++ signal substances to release them in response to the luminal stimuli. The substances are released not only in an endocrine fashion, but also, and more importantly, in a paracrine way, thus stimulating nervous, muscular, secretory and other elements in the vicinity. Attention should be paid also to other secretions of the gut endocrine cells, ATP and chromogranins (acidic carrier proteins) which are co-released with the peptides and amines. Various gut hormones have been demonstrated to be released into the gut lumen, besides into the blood and tissue spaces. The possible mechanism of this partial exocrine function of the endocrine cells remains to be explored.

Polymorphonuclear neutrophil leucocytes in childhood Crohn's disease: a morphological study.

Light and electron microscopy was applied to surgical resections and endoscopic biopsies from the ileum and colon of 15 children with Crohn's disease in order to investigate the involvement of neutrophils in the disease process. Clear evidence was found of neutrophil infiltration of the lamina propria and epithelium, neutrophil migration into the gut lumen through epithelial breaks and intact epithelium, neutrophil phagocytosis of luminal and lamina propria bacteria, and the presence of intracellular neutrophils in enterocytes. Similar findings were seen in 5 of 6 children with ulcerative colitis and in a case of an E. coli colitis, but not in 8 controls. The observations demonstrate the involvement of neutrophils in Crohn's disease in childhood and suggest that the response is directed, in part, against luminal enterobacteria and enterocytes.

Experience with the 'Triple Test' in pancreatic disease.

The results of the secretin-pancreozymin test, duodenal aspirate cytology and hypotonic duodenography (the Triple Test), performed during a single duodenal intubation in patients with pancreatic or ampullary carcinoma, chronic pancreatitis and non-pancreatic disease were analysed retrospectively. Thirty-five of 36 carcinoma patients and all 11 chronic pancreatitis patients had an abnormal result. One hundred and sixteen of 170 non-pancreatic disease patients had a normal result. It would appear that the Triple Test (TT) may be a useful screening test for pancreatic disease.

Measurement of gut hormonal peptides in biopsies from human stomach and proximal small intestine.

Using sensitive and specific radioimmunoassays, concentrations of hormonal peptides have been measured in small biopsies taken from the human stomach, duodenum, and proximal jejunum. Comparison is made of these hormone concentrations and the number of respective endocrine cells present determined by quantitative immunocytochemistry. Immunoreactive somatostatin, VIP, motilin, and gastrin were detected in all regions examined, whereas secretin and GIP were undetectable in antral extracts. Enteroglucagon-like immunoreactivity was present only at and beyond the ligament of Treitz, although a few enteroglucagon-producing cells were shown by immunocytochemistry in the duodenum. The variation of hormone concentration was found to be small in these biopsies of normal tissue within each region of the gut examined, indicating that representative hormone concentrations may be reliably obtained from small biopsy tissues. An attempt has been made to establish reference values for gut hormone concentrations in such biopsies; this may allow future study of any changes in concentration that may occur in pathological conditions.

The Lundh test: a review of its clinical use in the diagnosis of pancreatic disease.

The clinical value of the Lundh test in the diagnosis of pancreatic disorders was reviewed retrospectively for 139 patients with proven pancreatic disease (15 acute and 72 chronic pancreatitis, 51 carcinoma of the pancreas and one partial pancreatectomy). There was a good separation between patients with pancreatic disease and those with other gastrointestinal disorders who presented with similar symptoms. The test was most helpful in patients with chronic pancreatitis (diagnostic rate 89%, mean tryptic activity (MTA) less than 7 U), more particularly in those presenting with jaundice or steatorrhoea (100%) than pain (86%), but less successful (diagnostic rate 68%) in carcinoma of the pancreas (steatorrhoea 100%; jaundice 64%; pain 55%). Complete absence of bile from duodenal juice in jaundiced patients usually indicated pancreatic or hepatobiliary carcinoma. An abnormal but not diagnostic MTA (7 to less than 10 U) was seen in 7% of patients with chronic pancreatitis, 13% with carcinoma of the pancreas and 11% with non-pancreatic disorders and suggested the need for further pancreatic investigation. Cytological examination of duodenal juice increased the usefulness of the test. Although malignant cells were rarely seen, characteristic (degenerate) cells were found in 22 of 44 (50%) patients with, but only five of 85 (6%) without pancreatic disease, even when the MTA was normal. The Lundh test can be conveniently combined with a jejunal biopsy at the same intubation for the investigation of diarrhoea or steatorrhoea.