Background: Clinical and experimental data have revealed that
parenteral nutrition (PN) can lead to hypotrophy and dysfunction in the
morphology and physiology of the pancreas. These adverse alterations appear to
be related to many different factors. One important factor is the absence of a
gastrointestinal hormone, such as cholecystokinin, which is the most important
stimulator for the integrity of the pancreas. The level of cholecystokinin is
decreased during absent enteral feeding, and the stimulatory effect of
cholecystokinin is significantly reduced during PN. Methods: Original
and review articles, editorials, and case reports published primarily in
English and listed in MEDLINE/ISI up to September 2006 or identified by a
manual search have been reviewed in an attempt to provide a comprehensive
overview of the effects of PN on the exocrine pancreas in response to
cholecystokinin. Results: When hypercholecystokininemia, produced by
endogenous and exogenous procedures, is present during PN, the morphology and
functions of the pancreas are still unable to be fully reversed.
Conclusions: Other growth factors besides cholecystokinin are
probably involved in the pancreatic regulation, and enteral feeding seems to
be important for the full expression of the trophic effects of cholecystokinin
on the pancreas.
Cholecystokinin is a main stimulator of the pancreas, but its stimulatory effect on exocrine pancreas is decreased during long-term parenteral nutrition. This may be due to other factors besides cholecystokinin that are regulated in the exocrine pancreas during parenteral feeding.
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