Enkephalin in peripheral neuroendocrine tumours.
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Biomedical subjects
Publications and source records attributed to S N Sullivan.
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Persons with the irritable bowel syndrome (IBS) have a significantly higher prevalence of globus and migraine-like headache than age-matched control subjects. On the other hand, persons with organic disease of the esophagus or colon may have a reduced prevalence of functional symptoms involving the opposite end of the gastrointestinal tract. The dispersed pattern of symptoms in IBS suggests that some agent, such as a hormone, may be acting systemically.
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Morphine has powerful actions on brain and gut. Peptides with opiate-like actions (endorphins, enkephalins) are known to be normal constituents of the brain and now enkephalin-like immunoreactivity has been shown in the gut. Enkephalin-like immunoreactivity was present in all areas of the gut with particularly high concentration in the antrum and significant amounts in the upper small intestine. Immunocytochemistry on 1 micronm serial sections revealed enkephalin-like immunoreactivity in numerous cells of the antral mucosa, in a few cells of the duodenal mucosa and pancreas, and in the myenteric plexus of the gallbladder, cystic ducts, bileduct, and other areas of the lower intestine. Gastrointestinal physiology appears to be partly regulated by locally acting hormones and enkephalin may be one of these. The established effects of morphine on the alimentary tract provide a clue to the possible physiological role of enkephalin.
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Twenty-one chronic hemodialysis patients were investigated. While only two had radiologic evidence of peptic ulceration, three had markedly elevated basal acid outputs, thirteen had significantly elevated maximal acid outputs and seven had fasting duodenogastric reflux. Elevated fasting serum gastrin levels and prolonged gastrin circulation following stimulated endogenous release were also demonstrated. The abnormalities in gastric function may be explained by fasting and stimulated hypergastrinemia.
The availability of pure intestinal hormones and the development of radioimmunoassays for their measurement has expedited research into many aspects of gastrointestinal endocrinology. A complex balance evidently exists between the different intestinal hormones and also the rest of the endocrine system. Polyendocrinopathies have been described, and, so far, two diseases due to intestinal hormone excess (Zollinger-Ellison syndrome and the syndrome of watery diarrhea, hypokalemia and achlorhydria) elucidated. It seems likely that many more gastrointestinal endocrine diseases await discovery.
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