Gut hormones in gastrointestinal disease.

Considerable advances have been made in the understanding of the physiology of gut hormones. Thus, knowledge of the mechanisms of release and of the actions of many of the hormones is rapidly expanding. The known clinical importance of gut hormones is at present confined only to the excess production of gastrin, VIP, and pancreatic glucagon by endocrine tumours. The role of these three and the other gut hormones in disease states affecting the pancreas and gut has been studied little. Investigation of the patterns of gut hormone release in alimentary disease may provide new insight into the pathophysiology of these disorders. Not only may gut hormones be implicated as primary agents in the pathological processes, but also secondary changes in gut hormone release may be related to compensatory and adaptive mechanisms. Further insight may also be gained into the normal physiological roles of the hormones themselves through the effects of diminished or augmented release found in gut diseases. We have, therefore, studied the gut hormone profile after a normal meal in several well defined gastrointestinal diseases, with features summarised in Table 1. The distribution of the known gut hormones has been elucidated by the combined techniques of quantitative immunocytochemistry and radioimmunoassay of extracted tissues (Bloom et al., 1975; Bryant and Bloom, 1979). The hormones have characteristic locations which are summarised in Table 2. Diseases affect the alimentary tract in many different ways, some of them affecting only certain portions of the gut. It is to be expected that the release ofgut hormones from areas damaged by the disease would be abnormal. The release of other hormones from areas of bowel uninvolved in disease, however, might also show secondary changes. The plasma levels of most gut hormones rise substantially after food. Thus the stimulus to hormone release used in studying the various disease states was a 'physiological' test breakfast. This consisted of two medium-sized boiled eggs, 10 g butter, 60 g bread as toast, 35 g marmalade, and Disease or Area mavimally Clinical and pathological state affected pathologicalfeatures