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• W2465299300 abstract "Patencies of the pancreatic duct system in conjunction with normal exocrine function of pancreatic tissue are a prerequisite for adequate digestion and assimilation of nutrients. The key enzymes are amylase, lipase, trypsin, and chymotrypsin. Physiologic exocrine secretion is a cyclic phenomenon that is intimately linked to gastrointestinal (GI) motility. Sequential to gastric emptying, the exocrine secretion rate rises by three to six times within an hour and is back to the basal rate about 3 to 4 hours after ingestion.4 The quantity and duration of secretion positively correlate with the caloric value of food ingested, the free fatty acid content, the presence of certain amino acids (phenylalanine, valine, methionine, and tryptophan), the solidity of a meal, and osmolality. After a standard meal, the output of lipase rises by 3 to 6 times, and the output of amylase and trypsin rises by 10 to 20 times. To prevent rapid degradation of lipase, a duodenal pH of 6–7 is needed, and the amount of bicarbonate secreted into the duodenum is critical for fat digestion, as demonstrated by DiMagno and associates.5 There are two ways by which malignant tumors compromise intraluminal secretion of pancreatic enzymes. Apart from obstruction of the pancreatic duct, loss of functioning pancreatic parenchyma by progressive destruction by tumor is an important mechanism. Endoscopic retrograde cholangiopancreatography (ERCP) studies6 indicate that the severity of obstruction is directly proportional to the length of the opacified pancreatic duct and the proximity to the duodenum. Most exocrine tissue is contained at the head of the pancreas; tumor of this region constitutes 85% of all cases, and carries a dismal prognosis.5 The secretion does not decrease until 60% of the total length of the duct is involved. Perez et al found fat malabsorption rates in the range of 80%–90% in patients with PC before pancreaticoduodenectomy and in those who underwent pancreaticoduodenectomy 5 years Correspondence to: Muhammad Wasif Saif, MD, Division of Medical Oncology, 333 Cedar Street, FMP 116, New Haven, CT 06520; telephone: (203) 737-1569; fax: (203) 785-3788; e-mail: wasif.saif@yale.edu Dr. Damerla is a medical oncologist, Tulane University School of Medicine, New Orleans, Louisiana." @default.
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• W2465299300 date "2009-01-20" @default.
• W2465299300 modified "2023-09-26" @default.
• W2465299300 title "Pancreatic enzyme supplementation in pancreatic cancer." @default.
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