Cholecystokinin, a hormone released from endocrine cells of the upper small intestine in response to amino acids and fatty acids in chyme, has potent effects on gut smooth muscle contractility. Depending on the region of the gut, the effect of cholecystokinin may be neurally mediated, direct, or both. Neurally-mediated effects may be relaxant or contractile depending on the transmitter released by cholecystokinin. Based on mimicry by infusion of cholecystokinin to postprandial levels and the ability of specific cholecystokinin receptor antagonists to abolish effects of endogenous cholecystokinin released in response to a meal, three physiological effects of cholecystokinin, all of which are neurally-mediated, have been identified: contraction of the gallbladder mediated by cholecystokinin-induced release of acetylcholine, relaxation of the sphincter of Oddi mediated by cholecystokinin-induced release of vasoactive intestinal peptide and inhibition of gastric emptying mediated by cholecystokinin-induced activation of an inhibitory vago-vagal reflex involving vasoactive intestinal peptide-induced relaxation of the gastric fundus. Gallbladder contraction and relaxation of the sphincter of Oddi regulate the flow of bile, and inhibition of gastric emptying regulates the flow of chyme into the duodenum. Combined with the potent stimulation of pancreatic enzyme secretion by cholecystokinin, these effects insure optimal conditions for digestion and absorption of nutrients by the intestine.

Role of cholecystokinin in the regulation of gastrointestinal motility

Gastrointestinal motility in pregnancy.

Between 1989 and 1993, 62 patients underwent Whipple pancreatoduodenectomy and 75 pylorus-preserving pancreatoduodenectomy (PPPD); 35 patients in the first group and 37 in the second had pancreatic adenocarcinoma while 17 and 21 patients respectively had periampullary adenocarcinoma. The aim of this retrospective study was the comparison of operative outcome, nutritional recovery and survival of patients who underwent these two operations. No significant differences were found between the two groups in operative mortality or morbidity, duration of gastric aspiration and time to start of solid meals. Patients who underwent PPPD had a better nutritional recovery: the increase of both body-weight and serum albumin level at 6 months after discharge was significantly higher for those who had preservation of the whole stomach (P < 0.001 and P < 0.05 respectively). No significant difference in survival was found between the two procedures when patients with pancreatic or periampullary adenocarcinoma were analysed separately.

Comparison between pylorus‐preserving and Whipple pancreatoduodenectomy

The effects of chronic treatment with octreotide versus octreotide plus midodrine on systemic hemodynamics and renal hemodynamics and function in nonazotemic cirrhotic patients with ascites.

Gallbladder function in gallstone disease.

https://www.gastrojournal.org/article/0016-5085(90)90349-6/pdf

Effect of loxiglumide on gallbladder contractile response to cerulein and food in humans.

https://www.journal-of-hepatology.eu/article/S0168-8278(97)80247-4/pdf

Octreotide long-term treatment in patients with portal hypertension: persistent inhibition of postprandial glucagon response without major changes in renal function

The effect of two different single oral doses of loxiglumide (CR 1505, CAS 107097-80-3) on gall-bladder emptying induced by a 550-cal standard mixed meal in 6 healthy volunteers was studied. Following placebo, the maximal gall-bladder emptying occurred about 90 min after the meal (minimal residual gall-bladder volume 27.4% of basal volume). Loxiglumide 400 or 800 mg dose-dependently inhibited the physiologica gall-bladder emptying. Loxiglumide plasma levels dose-dependently increased. The inhibition of gall-bladder emptying and the kinetic of loxiglumide plasma levels were temporally related. The results of the present study confirm that oral loxiglumide is a potent orally active cholecystokinin (CCK) antagonist in man and that CCK is the major physiological mediator of gallbladder emptying in response to meal.

Dose-response effects of oral loxiglumide on postprandial gall-bladder emptying in man

The complete control of steatorrhea in post-surgical exocrine pancreatic insufficiency is difficult. The aim of this study was to evaluate the effect of the association of ranitidine with pancrelipase om fecal fat excretion in patients who had undergone a pancreatoduodenectomy with suppression of the exocrine pancreatic secretion by Neoprene injection. Ten patients were studied 1 year after surgery. Steatorrhea was measured as an integrated test of 3-day stools, while patients were kept on a diet of 100 g lipid/day, with their usual enzyme supplementation therapy (16,050 USP units of lipase/meal). A basal 24-h gastroenteric pH profile was also obtained. In the following month, patients had ranitidine (150 mg twice a day) in addition to pancrelipase. Then steatorrhea and gastroenteric pH were reassessed. Mean fecal fat was 26.9 (SD 13.7) g/day without ranitidine and 30.5 (SD 13.9) g/day during combined treatment. Body weight and nutritional parameters did not show any significant variation after ranitidine administration. Even in the absence of ranitidine, postprandial gastroenteric pH values were always > 4; the H2-receptor antagonist only reduced fasting gastric acidity. In conclusion, the gastroenteric pH and fecal fat determinations showed that ranitidine is not useful in patients with total postsurgical exocrine pancreatic insufficiency.

Fat absorption and gastroenteric pH profile in postsurgical pancreatic insufficiency: role of the association of H2-receptor antagonists with pancreatic enzymes.

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Effect of loxiglumide on gallbladder contractile response to cerulein and food in humans.

Octreotide long-term treatment in patients with portal hypertension: persistent inhibition of postprandial glucagon response without major changes in renal function

Dose-response effects of oral loxiglumide on postprandial gall-bladder emptying in man

Fat absorption and gastroenteric pH profile in postsurgical pancreatic insufficiency: role of the association of H2-receptor antagonists with pancreatic enzymes.