Gastroenterology -  Harvey J. Dworken

Gastroenterology (eBook)

Pathophysiology and Clinical Applications
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2014 | 1. Auflage
680 Seiten
Elsevier Science (Verlag)
978-1-4831-9267-3 (ISBN)
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Gastroenterology is based on its predecessor volume ''The Alimentary Tract'' but the content has been rewritten almost completely. The scope has been expanded to account for major developments in the field of gastroenterology and in order to make the volume more useful to house officers and practicing physicians. The text is designed to be read first, and then summarized if desired with illustrated lectures and demonstrations. This book is organized into 20 chapters. These chapters cover updated gastroenterological topics as of 1982 including symptoms, diagnosis and treatment of diverticular diseases of the colon and lower small intestine; the incidence and distribution of inflammatory bowel diseases; and classification and pathological mechanism of diarrheal disorders. This book will of interest to house officers and practicing physicians.
Gastroenterology is based on its predecessor volume "e;"e;The Alimentary Tract"e;"e; but the content has been rewritten almost completely. The scope has been expanded to account for major developments in the field of gastroenterology and in order to make the volume more useful to house officers and practicing physicians. The text is designed to be read first, and then summarized if desired with illustrated lectures and demonstrations. This book is organized into 20 chapters. These chapters cover updated gastroenterological topics as of 1982 including symptoms, diagnosis and treatment of diverticular diseases of the colon and lower small intestine; the incidence and distribution of inflammatory bowel diseases; and classification and pathological mechanism of diarrheal disorders. This book will of interest to house officers and practicing physicians.

CHAPTER 2

A Survey of Gastrointestinal Hormonology


Publisher Summary


This chapter presents a survey of the gastrointestinal hormonology. Most of the gastrointestinal hormones appear to have effects that are localized to the gut. Each of the gastrointestinal hormones is a polypeptide whose effects depend on its molecular structure. Gastrin and cholecystokinin (CCK), for example, possess identical four-amino residues at the carboxyl terminal of the polypeptide chain and have similar stimulant effects on the stomach, gall bladder, and pancreas. This residue alone is capable of producing the effects of the full molecule although not to the same degree. Similarly, the effect of CCK on the oxyntic—acid-secreting—cells of the stomach is not nearly as strong as the effects of equal amounts of gastrin even though it appears to have a stronger affinity for surface receptors on these cells. Because of this, equimolecular doses of CCK inhibit the full effect of gastrin in the secretion of acid. While hormones of the secretin family also have structural and functional similarities, the entire molecule is required to induce the key physiologic responses. These hormones include secretin, vasoactive intestinal polypeptide, gastric inhibitory polypeptide, and glucagon.

In the past twenty years, technological advances have permitted protein chemists to purify, characterize, and in many instances, synthesize an increasing number of gastrointestinal hormones. Immunochemical techniques have facilitated the identification of cellular sites in which these hormones are stored and perhaps produced. Radioimmunoassay has provided the mechanism for the measurement of these hormones in body fluids. The upper gastrointestinal tract has proved to harbor the largest, if not the most important, endocrine gland system in the body. Because many of the hormones produced in this system have effects on more than a single component of an organ, and indeed on more than one organ, it is worthwhile to obtain an overview of their actions prior to considering the physiology and pathophysiology of the organs individually.

Most of the gastrointestinal hormones appear to have effects that are localized to the gut. A few, such as enteroglucagon and somatostatin, have systemic effects as well. Of the multiple effects which they have been demonstrated to exert on the gastrointestinal tract in human beings and other animals, it is not clear in every case which are truly physiologic and which are merely incidental effects of pharmacologic doses. Thus, the exact importance in maintaining homeostasis, particularly of the candidate hormones, has not been established.

Each of the gastrointestinal hormones is a polypeptide whose effects depend on its molecular structure (Tables 2-1 and 2-2). Gastrin and cholecystokinin (CCK), for example, possess identical four-amino residues at the carboxyl terminal of the polypeptide chain and have similar stimulant effects on the stomach, gall bladder, and pancreas. This residue alone is capable of producing the effects of the full molecule, although not to the same degree. Similarly, the effect of CCK on the oxyntic (acid-secreting) cells of the stomach is not nearly as strong as the effects of equal amounts of gastrin, even though it appears to have a stronger affinity for surface receptors on these cells. Because of this, equimolecular doses of CCK inhibit the full effect of gastrin in the secretion of acid. While hormones of the secretin family also have structural and functional similarities, the entire molecule is required to induce the key physiologic responses. These hormones include secretin itself, vasoactive intestinal polypeptide (VIP), gastric inhibitory polypeptide (GIP), and glucagon.

Table 2-1

Gastrin-Cholecystokinin Family

Table 2-2

The Secretin-Glucagon Family

Secretin (27 amino acids, mol wt 3,055)

His-Ser-Asp-Gly-Thr-Phe-Thr-Ser-Glu-Leu-Ser-Arg-Lev-Arg-Asp-Ser-Ala-Arg-Leu-Gln-Arg-Leu-Leu-Gln-Gly-Leu-Val-NH2

Glucagon (29 amino acids, mol wt 3,484)

His-Ser-Gln-Gln-Thr-Phe-Thr-Ser-Asp-Tyr-Ser-Lys-Tyr-Leu-Asp-Ser-Arg-Arg-Ala-Gln-Asp-Phe-Val-Gln-Trp-Leu-Met-Asp-Thr

Vasoactive intestinal peptide (28 amino acids, mol wt 3,326)

His-Ser-Asp-Ala-Val-Phe-Thr-Asp-Asn-Tyr-Thr-Arg-Leu-Arg-Lys-Gln-Met-Ala-Val-Lys-Lys-Tyr-Leu-Asn-Ser-Ile-Leu-Asn-NH2

Gastric inhibitory polypeptide (43 amino acids, mol wt 5,104)

Tyr-Ala-Glu-Gly-Thr-Phe-Ile-Ser-Asp-Tyr-Ser-Ile-Ala-Met-Asp-Lys-Ile-Arg-Gln-Gln-Asp-Phe-Val-Asn-Trp-Leu-Leu-Ala-Gln-Gln-Lys-Gly-Lys-Lys-Ser-Asp-Trp-Lys-His-Asn-Ile-Thr-Gln

Other Gastrointestinal Peptides

Motilin (22 amino acids, mol wt 2,698)

Phe-Val-Pro-Ile-Phe-Thr-Tyr-Gly-Glu-Leu-Gln-Arg-Met-Gln-Glu-Lys-Glu-Arg-Asn-Lys-Gly-Gln

Pancreatic polypeptides (36 amino acids, mol wt 4,226)

Ala-Pro-Leu-Glu-Pro-Gln-Tyr-Pro-Gly-Asp-Asp-Ala-Thr-Pro-Glu-Gln-Met-Ala-Gln-Tyr-Ala-Ala-Glu-Leu-Arg-Arg-Tyr-Ile-Asn-Met-Leu-Thr-Arg-Pro-Arg-Tyr-NH2

Somatostatin (14 amino acids, mol wt 1,639)

H-Ala-Gly-Gys-Lys-Asn-Phe-Phe-Trp-Lys-Thr-Phe-Thr-Ser-Cys-OH

Bombesin (14 amino acids, mol wt 1,620)

Glp-Gln-Arg-Leu-Gly-Asn-Gln-Trp-Ala-Val-Gly-His-Leu-Met-NH2

Source: Go VLW, Owyang C. Radioimmunoassay of gastrointestinal hormones. In: Glass GB, ed. Progress in Gastroenterology, vol 3. New York: Grune and Stratton, 1977:156. Reprinted by permission.

PRESUMED MECHANISM OF HORMONAL ACTION


Peptide hormones bind to specific receptors on target cell membranes. This first step in mediation of the effect of the hormone on specific cells has been demonstrated in a number of instances, examples of which are the binding of 125I-gastrin to canine antral smooth muscle, and of 125I-secretin to hepatocytic plasma membranes. Binding alone is only a first step, since nonspecific or inhibitory binding may also occur. Some further alteration of target cells, proportional to the amount of hormonal binding, must occur—the hormonal response. One such measurable response is the intracellular activation of the enzyme adenylate cyclase at cellular membranes, with the resultant production of adenosine 3′5′-monophosphate (cyclic AMP) from cytoplasmic adenosine triphosphate (ATP). But Gardner (1979) has pointed out that this response may not correlate with the observed functional changes in the cell, and that target cells may respond to stimulation with specific hormones by means other than the generation of cAMP. However, where hormone binding, cAMP release, and effector cell responses all occur proportionately and at the same time in the same system, a clear cause and effect relationship can be assumed. Since these conditions have been met infrequently in the case of gastrointestinal hormones, our understanding of their mechanisms of action is only presumptive at present. The variety of actions attributable to gastrointestinal hormones is summarized in Table 2-3.

Table 2-3

Effects of Gastrointestinal Hormones on Digestive Tract

Main effects are indicated. For physiologic importance of each, see text. S = stimulatory; I = inhibitory.

ESTABLISHED GASTROINTESTINAL HORMONES


Secretin, CCK, and gastrin have been identified, characterized, and proved to have important physiologic significance. They are thus agreed to be established gastrointestinal hormones. Since pancreozymin has been found to be identical to CCK, it is no longer considered as a separate hormone.

Secretin


Secretin [molecular weight (mol wt) 3,073, 27 amino acids] is the first of all hormones to have been discovered, its effects on the pancreas having been noted by Bayliss and Starling in 1902. It is secreted throughout the small intestinal mucosa by granular intervillous cells (S-cells) that are concentrated mainly in the duodenum and jejunum. Secretin is released primarily by hydrogen ions in a concentration below pH 4.5, a response that is probably enhanced by cholinergic innervation.

The major effect of secretin is in stimulating the secretion of bicarbonate and water by the pancreatic ductal system, thereby washing preformed pancreatic digestive enzymes already in the ductal system into the upper small intestine. The hormone also stimulates the secretion of pepsinogen, increases the tone of the pyloric sphincter, and enhances the action of CCK on the gall bladder. In physiologic amounts it also has the following inhibitory effects: reduction of the release of glucagon and gastrin, reduction of the amount of hydrochloric acid secreted by the stomach in response to a dose of gastrin, inhibition of the tonic contraction of the lower esophageal sphincter and of peristalsis of the stomach and intestine, and reduction of the absorption of water from the small intestine.

Cholecystokinin


Cholecystokinin (mol wt 3,918, 33 amino acids) is synthesized maximally in the jejunum and to a lesser degree in the duodenum and ileum in large, round, dense mucosal I cells. CCK has also been found in the cerebral cortex of rats (Pinget et al 1978). CCK is released maximally by fat; L-amino acids and peptides are also effective. Hydrochoric acid causes a lesser release of CCK.

The major physiologic effects of CCK are the stimulation of contraction of the gall bladder, and the release of enzyme-containing zymogen granules from pancreatic acinar (A) cells. CCK...

Erscheint lt. Verlag 24.4.2014
Sprache englisch
Themenwelt Sachbuch/Ratgeber Gesundheit / Leben / Psychologie Krankheiten / Heilverfahren
Medizin / Pharmazie Allgemeines / Lexika
Medizin / Pharmazie Medizinische Fachgebiete
ISBN-10 1-4831-9267-9 / 1483192679
ISBN-13 978-1-4831-9267-3 / 9781483192673
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