Aging and Exocrine Pancreatic Function Evaluated by the Recently Standardized Secretin Test

• Published in: Nihon Rōnen Igakkai zasshi Vol. 28; no. 5; pp. 599 - 605
• Main Authors: Matsumoto, Shuji, Harada, Hideo, Ochi, Koji, Seno, Toshinobu, Tanaka, Juntaro, Kimura, Ikuro, Miyake, Hirofumi, Ishibashi, Tadaaki, Oka, Hiroo
• Format: Journal Article
• Language: Japanese
• Published: Japan The Japan Geriatrics Society 1991
• Subjects: Adult; Aged; aging; Aging - physiology; Amylases - metabolism; Bicarbonates - metabolism; chronic pancreatitis; exocrine pancreatic function; Female; Humans; Lipase - metabolism; Male; Middle Aged; Pancreas - physiology; Pancreatic Juice - metabolism; Prospective Studies; Secretin; secretin test
• ISSN: 0300-9173
• DOI: 10.3143/geriatrics.28.599

The authors studied the relationship between aging and exocrine pancreatic function by the secretin test which was recently standardized by the Japanese Society of Gastroenterology. Pancreatic juice was collected at 10min intervals for 60 minutes after a bolus intravenous injection of secretin (Secrepan, Eisai Co., Ltd., 100U/body) through a quadruple-lumen doudenal tube equipped with double balloons. Exocrine pancreatic function was evaluated by three parameters: secretory volume, maximal bicarbonate concentration or bicarbonate output, and enzyme (amylase and lipase) output. Control subjects consisted of 65 outpatients presenting with mild vague abdominal symptoms who fulfilled the following three criteria: 1) good general condition with no known diseases; 2) no abnormality in the liver, bile duct, pancreas, kidney and metabolism judged from blood chemistry, urine and stool analysis, upper GI series, abdominal ultrasonography (US), and endoscopic retrograde cholangiopancreatography (ERCP); 3) alcohol consumption <25g/day. Control subjects were divided into three groups: 15 subjects below 40 years of age (group A), 32 subjects from 40 to 65 years (group B), and 18 subjects of 65 years and above (group C). Nineteen patient with chronic pancreatitis were also studied. The group C showed significantly lower values in secretory volume, bicarbonate output, and enzyme output than group A and B. Enzyme output showed a gradual decrease with aging. However, secretory volume and bicarbonate output showed a gentle convex curve with a peak around age 40 and a rather steep down-slope after late 50s. The degree of the decrease was significantly more marked in volume and bicarbonate output than in enzyme output in group C. Abnormally low values in more than two parameters were found in 10 of the 18 subjects of group C. No distinctive features which permitted distinguishing exocrine pancreatic dysfunction in group C from that in 19 patients with chronic pancreatitis were found. Exocrine pancreatic function (both duct-cell function and acinar-cell function) significantly decreased in the elderly. The age-associated decrease shows a different pattern between duct-cell and acinar-cell function. The degree of duct-cell dysfunction was significantly higher than that of acinar-cell dysfunction in the elderly. In the elderly, exocrine pancreatic function tests are unreliable in making a diagnosis of chronic pancreatitis, so that clinical symptoms and findings and findings of imaging tests (US, CT and ERCP) should be taken into consideration for the correct diagnosis.