To test the hypothesis, based on studies in healthy man and dog, that patients with impaired digestion due to severe
pancreatic insufficiency have impaired postprandial
cholecystokinin (CCK) secretion that can be improved by the addition of pancreatic
enzymes, we have studied plasma CCK responses to a test meal with and without addition of pancreatic
enzymes in 10 patients with
pancreatic insufficiency and
steatorrhea, in 8 patients with
chronic pancreatitis without
steatorrhea, and in 6 healthy subjects. The patients with
steatorrhea had a significantly (P less than 0.001) lower integrated plasma CCK response to the meal (177 +/- 23 pM.150 min) than the healthy subjects (468 +/- 41 pM.150 min), while patients with
chronic pancreatitis without
steatorrhea had an intermediate integrated postprandial CCK secretion (327 +/- 101 pM.150 min). Addition of pancreatic
enzymes to the meal significantly augmented the integrated CCK response in both the patients with
steatorrhea to 483 +/- 72 pM.150 min (P less than 0.01) and in those without
steatorrhea to 480 +/- 85 pM.150 min (P less than 0.05). These values were not significantly different from those in the healthy subjects (521 +/- 86 pM.150 min). Integrated CCK secretion in the three groups during
bombesin infusion was similar (patients with
steatorrhea 134 +/- 23 pM.20 min, patients without
steatorrhea 131 +/- 33 pM.20 min, and healthy subjects 146 +/- 28 pM.20 min), indicating a normal capacity to secrete CCK in response to a humoral stimulus. These data are in agreement with the suggestions from previous studies that digestion of nutrients by pancreatic
enzymes plays an important role in the regulation of plasma CCK secretion after feeding.