Katsuhide Shimakura

A Study of Chronic Pancreatitis by Serial Endoscopic Pancreatography

The pancreatic duct system was studied with repeated endoscopic retrograde pancreatography in 31 patients with chronic pancreatitis, 32 patients with suspected chronic pancreatitis, and 16 controls without pancreatic disease. In chronic alcoholic pancreatitis the pancreatograms showed marked changes during the initial examination with progression even after abstinence or reduction of drinking. In the alcoholics with suspected chronic pancreatitis, progressive lesions in branch ducts with almost intact main ducts were recognized. In contrast, no remarkable alterations on serial pancreatograms were observed in nonalcoholic cases with definite or suspected chronic pancreatitis. These results suggest that pancreatic duct lesions play an important role in the development and progression of chronic alcoholic pancreatitis in contrast to chronic nonalcoholic pancreatitis.

Study of Chronic Alcoholic Pancreatitis by Means of Serial Pancreozymin-Secretin Tests

Fourteen patients with suspected chronic alcoholic pancreatitis (CAP) and 21 patients who had been shown to have the disease were followed up by the pancreozymin-secretin test in order to clarify the serial changes in exocrine pancreatic function in alcoholic pancreatitis. The initial and final test data for secretory volume, maximal bicarbonate concentration, bicarbonate output (BO), and amylase output (AmO) of exocrine secretion were compared in these two groups. Patients with suspected CAP showed a significant serial decrease only in AmO; definite CAP developed in 3 of them during the follow-up period. In definite CAP, a significantly progressive decrease in BO as well as AMO was observed. It is suggested that in the earlier stage of CAP, AMO is initially affected, whereas decreased secretion of both bicarbonate and enzyme becomes apparent in the later stage.

A case of asymptomatic primary biliary cirrhosis with an initial presenting feature of localized gastric varices.

SummaryA case of asymptomatic primary biliary cirrhosis (PBC) with an initial presenting feature of localized gastric varices is reported.The patient, 64 years old female, underwent a barium meal examination because of ill-defined abdominal complaints and was found to have gastric varices localized at the cardia but no esophageal varices. Her blood chemistry showed high values of biliary tract enzymes such as alkaline phosphatase and gamma-glutamyl transpeptidase, but the serum bilirubin level was almost normal. Serum anti-mitochondrial antibody was positive. Histological findings of the surgically biopsied liver specimen were compatible with PBC. The clinical implication of gastric varices in PBC is discussed.

Exocrine pancreatic function in asymptomatic chronic alcoholics without structural pancreatic disease

SummaryIn order to elucidate the functional states of the pancreas in the asymptomatic latent stage of chronic alcoholic pancreatitis, 45 chronic alcoholics with no obvious pancreatic structural abnormalities judged by endoscopic pancreatography were studied by pancreozymin-secretin test. We found three patterns of exocrine pancreatic function in alcoholics with or without cirrhosis: normal secretion (40%), hyposecretion (29%) and hypersecretion (31%). In the hyposecretory group, the amylase output proved to be impaired more frequently. In the hypersecretory group increases were observed in one or more of the following parameters, volume, bicarbonate output and amylase output. However, increase in volume was a fundamental condition in this hypersecretion. This study confirmed that exocrine pancreatic hyposecretion and hypersecretion were almost equally frequent in asymptomatic chronic alcoholics with no obvious pancreatographic abnormalities. These results suggest that ongoing exocrine pancreatic dysfunctions exist in the subclinical stage of chronic alcoholic pancreatitis.

Sixteen years follow-up of a patient with alcoholic pancreatitis: Serial findings of morphology and function on the pancreas and the liver

SummarySixteen years follow-up was performed in a male of long-standing alcohol indulgence who had an alcoholic liver disease at the outset, followed by alcoholic pancreatitis which progressed finally to pancreatic calcification. During this course, the abnormalities of endoscopic pancreatogram were unremittingly progressive, whereas exocrine and endocrine pancreatic dysfunction remained fluctuating, but ultimately deteriorated. In contrast functional and histological abnormalities of the liver were not progressive but returned toward normal.The follow-up observations in this case suggest that some cases of typical alcoholic pancreatitis may have unremittingly progressive morphologic changes with fairly well reserved capacity of exocrine and endocrine pancreatic functions and their hepatic lesions may not be in paralell with pancreatic lesions.