Intrajejunal administration of an elemental diet at neutral pH avoids pancreatic stimulation: Studies in dog and man*

Summary o 1.An elemental diet (Vivonex 100) stimulates pancreatic secretion when instilled into the stomach of dogs. 2.When Vivonex 100 at near neutral pH is perfused through a Thirty-Vella loop, pancreatic secretion is not stimulated significantly. 3.A mixture of essential and nonessential amino acids and a mixture of phenylalanine, leucine, and tryptophan (which are the strongest stimulators of pancreatic secretion in the dog), when perfused through a Thirty-Vella loop at neutral pH and in the concentration present in Vivonex 100, cause minimal stimulation of pancreatic secretion. 4.When the same amino acid mixtures acidified to a pH of 3.5 are perfused through a Thirty-Vella loop, strong pancreatic stimulation occurs. 5.Perfusion of hypertonic glucose solution (22.6 per cent) in a Thirty-Vella loop inhibits protein and bicarbonate output from the pancreas. 6.When 22.6 per cent glucose solution is introduced into the stomach, pancreatic secretion is stimulated. 7.When amino acid mixtures in the concentration present in Vivonex 100 are instilled into the stomach, strong stimulation of pancreatic secretion results. 8.The foregoing information emphasizes the importance of bypassing the stomach and minimizing acid secretion to keep the pancreas at rest. 9.Measurements of net absorption from the Thirty-Vella loop suggest that sodium chloride enhances glucose absorption. 10.Hypertonic glucose appears to inhibit amino acid absorption from a jejunal loop. 11.Separation of the amino acids and the glucose for intrajejunal feedings may improve the absorption of amino acids. This may be of particular importance in feeding elemental diets to patients with the short bowel syndrome.