Increased Postprandial Response of Glucagon-Like Peptide-2 in Patients with Chronic Pancreatitis and Pancreatic Exocrine Insufficiency

Background/Aims: Glucagon-like peptide-2 (GLP-2) is a nutrient-released gastrointestinal (GI) hormone that acts as an intestinal growth factor, and exogenous GLP-2 has been shown to increase superior mesenteric artery (SMA) blood flow. We aimed to investigate how assimilation of nutrients affects postprandial GLP-2 responses and to correlate these with postprandial SMA blood flow. Methods: Responses of the GI hormone glucose-dependent insulinotropic polypeptide (GIP) and GLP-2 were measured following an 80-min liquid meal test in 8 patients (6 males) with chronic pancreatitis (CP) and pancreatic exocrine insufficiency (PEI) and 8 healthy control subjects (5 males). Postprandial GI hormone responses were correlated with change in SMA flow as assessed by the resistance index. Results: Patients with CP and PEI exhibited the greatest postprandial GLP-2 responses (1,870 8 249 vs. 1,199 ± 108 pM·80 min, p = 0.027). No difference was observed with regard to GIP. GLP-2, but not GIP, responses correlated significantly with postprandial SMA flow. Conclusion: These results suggest that delayed assimilation of nutrients in patients with CP and PEI increases the secretion of GLP-2 - possibly due to delivery of a larger nutrient load to the distal part of the small intestine, where GLP-2 secreting L-cells are abundant - and that this hypersecretion of GLP-2 is associated with a higher SMA flow.