The 5th Seoul International Digestive Disease Symposium : Pathophysiology and Treatment of Pancreatic Steatorrhea:New Concepts

(Eugene P. DiMagno) 대한소화기학회 1999 SIDDS Vol.5 No.-

Pancreatic Cancer - Clinical Presentation , Pitfalls and Early Clues

(Eugene P. Dimagno) 대한소화기학회 1999 대한소화기학회 추계학술대회 Vol.1999 No.-

개의 실험적 췌외분비 부전에서 세균성 Lipase 의 용량 및 제형이 장통과에 미치는 영향

이상인,박효진,강진경,문영명,정재복,이세준,정준표,문병수,이관식,송시영,DiMagno, Eugene P. 대한소화기학회 2000 대한소화기학회지 Vol.35 No.5

Background/Aims : We determined in canine exocrine pancreatic insufficiency (EPI) when fed a high fat meal if 1) lipolytic activity as bacterial lipase (BL) alters intestinal transit (IT) dose dependently, 2) different formulations of BL have different dose responses, 3) correction of steatorrhea is related to IT. Methods : Five dogs underwent ligation of pancreatic ducts and insertion of duodenal and ileal cannulas. Perfusion and 72-hr fecal balance studies were performed while a high fat meal (fat 43%) was eaten. Powder or microtablet BL were given at doses ranging from 0 to 400×103 IU. IT of liquid and solid meal markers was evaluated by total delivery (% total amounts delivered to ileum), AUC (area under curve), T10 and T4 (minutes for 10% or 4% of ingested markers to travel from duodenum to ileum). Results : IT of the solid meal marker was not related to doses or formulations of BL. However, slowing of IT of the liquid meal marker was dose, but not formulation dependent (total delivery, p=0.0004; AUC, p0.0017; T10, p=0.0245). Greater fat absorption was associated with slower IT of the liquid but not the solid meal marker (r2=0.262, p=0.0213). Conclusions : In dogs with EPI fed a high fat diet, slower IT of liquids is dose- but not formulation-dependent and slowing of IT of liquids correlates with greater fat absorption.

개의 실험적 췌외분비부전에서 세균성 Lipase의 용량 및 제형이 위배출에 미치는 영향

이상인,강진경,문영명,정재복,이세준,정준표,이관식,송시영,박효진,DiMagno, eugene P . 대한소화기학회 1999 대한소화기학회지 Vol.34 No.4

Background/Aims: There are few reports about the changes of gastric emptying (GE) in canine exocrine pancreatic insufficiency (EPI). In this study, we would like to determine whether bacterial lipase (BL) containing lipolytic activity alters GE in a dose-dependent way, different formulations of BL have different dose responses, and GE is affected by fat absorption. Methods: Five dogs underwent ligation of pancreatic ducts and insertion of duodenal cannulas. Perfusion and 72-hr fecal balance studies were performed while a high fat meal (fat 43%) was given. Powder or microtablet shaped BL were given at doses ranging from 0 to 400×103 IU. GE of liquid and solid meal markers was evaluated by total delivery (% total amounts delivered to duodenum), AUC (area under curve), T10 and T50 (minutes for 10% or 50% of ingested markers to arrive in duodenum). Results: GE of liquid meal marker was delayed in a dose-dependent way, but showed no formulation dependency. GE of solid meal marker was also delayed in dose-dependen way. Fat absorption was associated with delay of GE of liquid meal marker but it is not associated with GE of solid meal marker (p=0.0013). Conclusions: In dogs with EPI which took a high fat diet, GE of liquid and solid meal is delayed in a dose-dependent way, but not in formulation-dependent way. In addition, delay of GE of liquid meal correlates with fat absorption.

개의 실험적 췌외분비부전에서 단백과 탄수화물의 흡수가 지방 흡수에 미치는 영향

정준표,정재복,박승우,이세준,문병수,송시영,이관식,이상인,문영명,강진경,Eugene, P. Dimagno 대한소화기학회 2002 대한소화기학회지 Vol.40 No.2

목적: 췌외분비부전에 의한 지방변의 치료는 아직 난제로서 이를 해결하기 위해서는 지방 흡수에 영향을 미치는 요인을 밝히는 것이 필요하다. 식이가 지방 흡수에 영향을 미치는 것으로 알려져 있으나, 아직 지방, 단백 및 탄수화물 등의 흡수에 있어서 상호 관련성 여부에 대해서는 잘 알려져 있지 않다. 본 연구에서는 개의 실험적 췌외분비부전에서 지방, 단백 및 탄수화물 등의 흡수가 효소 제제(세균성 리파제, 돼지 췌효소제) 및 용량 의존적인지, 지방 흡수가 단백 및 탄수화물의 흡수와 연관되는지 등을 알아보고자 하였다. 대상 및 방법: 20 ㎏ 내외의 암컷 mongrel 개 5마리를 사용하였고, 주-부췌관을 결찰-분리하여 췌외분비 부전을 유발하였다. 효소제의 제형은 모두 분말을 사용하였으며, 용량은 세균성 리파제와 돼지 췌효소제 각각 7.500, 15,000, 30,000 IU을 사용하여 무순서로 실험하였고, 무치료 대조실험도 시행하였다. 실험식이로는 고지방식이{850 Cal, 지방 43% (80.2 g), 단백질 36% (151.6 g), 탄수화물 21% (98.2 g)}를 사용하였다. 72시간 동안 대변을 수집하여 대변내 지방, 단백 및 탄수화물의 양을 측정하였고, g/24 hr로 환산하였다. 지방, 단백 및 탄수화물의 coefficient of fat absorption (CFA), coefficient of protein absorption (CPA) 및 coefficient of carbohydrate absorption (CCA)을 계산하였으며, 다중회귀분석을 이용하여 통계 처리하였다. 결과: CFA, CPA 및 CCA 모두 췌효소제의 용량 의존적으로 증가하였으며(각각 p<0.001), CFA와 CPA는 돼지 췌효소제가 세균성 리파제보다 더 컸으나(각각 p=0.002 및 p<0.001), CCA는 효소제의 종류와는 무관하였다. CPA가 증가할수록 CFA는 증가하였으며(p<0.001), CCA가 증가하여도 CFA는 증가하였다(p<0.001). 결론: 개의 실험적 췌외분비부전에서 지방, 단백 및 탄수화물의 흡수는 췌효소의 용량 의존적으로 증가하고, 돼지 췌효소제가 세균성 리파제보다 지방 및 단백의 흡수에 유리하며, 단백과 탄수화물의 증가는 지방의 흡수를 증가시킨다. 따라서 단백과 탄수화물의 흡수를 극대화하도록 식이를 조절하면 지방 흡수를 증가시킬 수 있을 것으로 생각된다. Background/Aims: Interactions among fat, protein, and carbohydrate absorption may play a role in the treatment of steatorrhea. We determined in canine exocrine pancreatic insufficiency (EPI) whether fat, protein, and carbohydrate absorptions are dependent on the pancreatic enzyme preparation (bacterial lipase, BL; porcine lipase, PL) and whether absorption of fat is related to absorptions of protein and carbohydrate. Methods: Five dogs underwent ligation of pancreatic ducts. Then, seventy two-hour fecal balance studies were performed while a high fat meal (fat 43%) was given. Powdered BL or PL was given at doses of 0, 7,500, 15,000, and 30,000 IU. Stool fat, protein, and carbohydrate were measured and coefficients of fat (CFA), protein (CPA), and carbohydrate (CCA) absorptions were calculated. Multiple regression analysis was used for statistical analysis. Results: CFA and CPA increased preparation (PL is better than BL) and dose dependently. However, CCA increased dose-dependently but not preparation-dependently. Fat absorption increased as protein and carbohydrate absorption increased (p<0.001). Conclusions: In dogs with EPI fed a high fat diet, porcine pancreatic enzyme increases fat and protein absorption greater than bacterial lipase, and the increase of fat absorption is related to the increase of protein and carbohydrate absorptions.

개에서 회장내 단백이 췌효소 및 담즙분비와 위배출 및 소장주행 시간에 미치는 영향

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),정재복(Jae Bock Chung),이상인(Sang In Lee),송시영(Si Young Song),정준표(Jun Pyo Chung),(Hiroshi Tohno),(eugene P . DiMagno) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6

N/A The aim of this study is to determine if protein in the ileum of dogs affects postprandial pancreaticobiliary secretion, gastric emptying, small bowel transit time, and circulating levels of gastrointestinal regulatory peptides such as peptide YY (PYY), neurotensin (NT), and pancreatic polypeptide (PP). Five dogs were prepared with permanent infusion and aspiration catheters in the duodenum and ileum. Ileal infusion (2 ml/rnin) was begun coincidentally with feeding a 300 Cal mixed nutrient meal containing both a iiquid marker (PEG 4000) and a solid marker (99mTc-sulfur colloid) in a conscious state of dogs. Ileal infusates were isosmolar solutions containing either 0.9% NaCl (control study) or 20 mg/rnl of protein solution (protein infusion study) in the 3:1 ratio of casein to essential amino acids. The secretory pattern of amylase and lipase was parallel, but. the secretion of trypsin was non-parallel to secretion of amylase and lipase. The pattern of exocrine pancreatic enzyme secretion was similar both in control and intraileal protein infusion studies. The secretion of exocrine pancreatic enzymes including amylase, lipase and trypsin, were increased by intraileal protein infusion compared with their secretion in control studies, and the secretion of amylase was significantly decreased (p<0.02) by intraileal protein infusion compared with their results in control studies. Although gastric emptying of both liquid and solid meals was delayed by the intraileal infusion compared with the control studies, there was no significant delay in gastric emptying (Tl/ 2) of liquid, whereas significant difference was noticed in gastric emptying (Tl/4) ol solid (p<0.02) between the control and intraileal protein infusion studies. The small bowel transit time was significantly prolonged (p<0.01) by intraileal protein infusion compared with time measured in control studies. The mean serum levels of PYY and NT were increased by intraileal protein infusion compared with those of control studies, but the mean serum level of PP was not changed. ln conclusion, it is suggested that intraileal protein riiay promote digestion and absorption of nutrients by increasing the enzyme secretion of the pancreas, delaying gastric emptying and prolonging small bowel transit time which may be influenced by hormones such as PYY and NT.