Surgical Considerations in the Short Bowel Syndrome
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
The status of the other digestive organs is an important determinant of outcome. The stomach influences oral intake, mixing of nutrients, transit time, pancreatic secretion, and protein absorption. Since SBS patients typically develop hyperphagia, which aids in intestinal adaptation, loss of the stomach, which is fortunately uncommon in the setting of SBS, would be a limiting factor [24,25]. Therefore, patients with a history of a Roux-en-Y gastric bypass for obesity, for example, may benefit from reconstruction of the stomach. Pancreatic enzymes are important in the digestive process and particularly influence fat absorption. The colon absorbs fluid and electrolytes, slows transit, and participates in the absorption of energy from malabsorbed carbohydrates [26–28]. Compared with an end-jejunostomy (type 1 anatomy), a jejunoileal anastomosis with an intact colon (type 3 anatomy) is equivalent to 60 cm of additional small intestine, and a jejunocolic anastomosis (type 2 anatomy) is equivalent to about 30 cm of additional small intestine [19] (Figure 21.1). The presence of the colon is also important in children with very short and ultrashort small bowel [29].
The Digestive (Gastrointestinal) System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The pancreas, located behind the stomach, contains digestive exocrine cells in addition to its endocrine function. Pancreatic enzymes are capable of digesting fats, carbohydrates, and proteins, and they are carried by an alkaline bicarbonate solution that neutralizes stomach acid. These juices act to convert the chemical environment from acidic to alkaline, which is more amenable to the intestines. Although the liver lies outside the digestive tract, it is considered a part of this system because of its many functions relating to digestion. It modifies all types of food substances, including fats, to enable utilization by body tissues. The gallbladder, a small, pear-shaped, sac-like organ located under the right lobe of the liver, serves as a storage area for excess bile before it passes into the duodenum.
Fetal and Neonatal Development of the Exocrine Pancreas
Jean Morisset, Travis E. Solomon in Growth of the Gastrointestinal Tract: Gastrointestinal Hormones and Growth Factors, 2017
Owing to limited data available in humans, whether pancreatic enzymes are altered in response to changes in diet has not been fully demonstrated. The limited human studies available agree with findings in animals. Synthetic and secretory responses to dietary variations have been reported. Premature infants fed a high-starch diet had a 10-fold increase in luminal amylase concentration, but because of an extremely low initial concentration, no meaningful improvement in amylase level in duodenal aspirate and no change in clinical parameters (i.e., starch digestion and absorption) were noted.45 It was shown by the same investigators that a high-protein diet resulted in an increase in trypsin and chymotrypsin concentration in the duodenal aspirate. We have previously demonstrated that in premature infants, feeding with a soy-based formula resulted in higher pancreatic lipase and trypsin secretion upon stimulation by secre-tagogues as compared to age-matched infants fed milk-based formulas.46
Prognostic value of serum lipase levels in patients with small bowel obstruction
Published in Baylor University Medical Center Proceedings, 2018
Fathima Z. Kamil Faiz, Sasha Mehrabian, Mahak Saad, Gabriel M. Aisenberg
Another hypothesis explaining the elevation of pancreatic enzymes comes from studies including patients with bariatric surgery. It is thought that the lipase elevation results from increased intraluminal back pressure caused by the obstruction. This can lead to a reflux of intestinal content into pancreatic and biliary ducts that subsequently activates pancreatic zymogens. This concept is referred to as reflux pancreatitis, and in the referenced study, it did not carry increased mortality or risk of pancreatic necrosis.5 Interestingly, experimental bowel obstructions in animal models showed that the necrotic intestinal epithelium of strangulated obstruction releases amylase. This was not noted in mild obstruction unless the animals were moribund; in this study, the canine pancreas showed no micro- or macroscopic evidence of pancreatitis.14
Future Research Directions for the Trophoblast Model of Cancer
Published in Nutrition and Cancer, 2018
Colin A. Ross
Most doctors are taught that pancreatic enzymes have only one purpose, to help with digestion in the small bowel after food leaves the stomach. However, PAR receptors are found throughout the body and are involved in many different processes, including regulation of cancer cell progression (27–30). There is ongoing research in many labs around the world on the functions of PAR and how they are regulated. A protease is an enzyme that breaks down protein, whereas a lipase is a protein that breaks down lipids, or fats. Trypsin, which is a protease, cuts off part of the PAR receptor as if it is partially digesting it, which activates the receptor, which in turns activates processes inside the cell. PARs exhibit a property known as biased agonism (27,30): they can be activated by more than one signal and can have different functions depending on the activating signal. Additionally, PARs can interact with each other. The biology of PARs is complex and the research literature on them is very technical, but PARs provide a starting point for research on the ability of trypsin to treat cancer.
Enzyme therapy: a forerunner in catalyzing a healthy society?
Published in Expert Opinion on Biological Therapy, 2020
Saptashwa Datta, K Narayanan Rajnish, C George Priya Doss, S. Melvin Samuel, E. Selvarajan, Hatem Zayed
A series of exopancreatic progressive fibroinflammatory diseases that damage the gland over time (years) are collectively termed chronic pancreatitis. The three classifications of chronic pancreatitis are chronic calcifying pancreatitis, chronic obstructive pancreatitis, and steroid-responsive pancreatitis. The disease is characterized by abdominal pain, exocrine pancreatic insufficiency, and diabetes, which are progressively visible with time. Pancreatic enzyme replacement therapy has been used for the therapy of insufficient production of exocrine pancreatic enzymes in chronic pancreatitis. The enzyme supplements are initially given at low doses, which are increased depending on the response of the person to the therapy. However, failure of pancreatic enzyme replacement therapy due to overgrowth of intestinal bacteria and deactivation by gastric juices has been observed in multiple cases [102].
Related Knowledge Centers
- Amylase
- Exocrine Pancreatic Insufficiency
- Malabsorption
- Pancreatic Cancer
- Protease
- Cystic Fibrosis
- Pancreatitis
- Pancreatic Lipase Family
- Pancreatectomy
- Renal Cysts & Diabetes Syndrome