Table Of ContentGlucaqon in Galtroenteroloqy
Glucaqon
in Galtroenteroloqy
Edited by J.Picazo,m.D.
The Proceedings of an International
Workshop held in Madrid on 31 May 1978
under the auspices of the Medical School of
the Universidad Complutense, Madrid.
MTPPR
LIMITED
International Ma:1ical Publishers
Published by
MTP Press Limited
Falcon House
Lancaster, England
Copyright © 1979 MTP Press Limited
Softcover reprint of the hardcover 1st edition 1979
All rights reserved. No part of this publication
may be reproduced, stored in a retrieval
system, or transmitted in any lorm or by any
means, electronic, mechanical, photocopying,
recording or otherwise, without prior
permission'from the publishers.
ISBN-13:978-94-009-9214-6 e-ISBN -13:978-94-009-9212-2
DOl: 10.1007/978-94-009-9212-2
Phototypesetting by Rainbow Graphics, Liverpool
Contents
List of Participants 7
Preface 9
Glucagon as a drug
A. Gomez-Pan, G. Blesa Malpica,
M.D. Rodriguez Arnao and A. Oriol Bosch 11
2 The physiological role of glucagon in the
gastrointestinal tract
D.L. Wingate and E. Pearce 19
Discussion 35
3 The role of glucagon in different endoscopic
procedures in the upper gastrointestinal tract
J. Myren 39
Discussion 50
4 The use of glucagon in colonoscopy
B. Ek 53
Discussion 58
5 Glucagon in radiology
L. Kreel 61
Discussion 82
5
Glucagon in Gastroenterology
6 Biliary surgery, radiomanometry and
glucagon
M.-J. Treffot, F. Quilichini and
M.-F. Vinson 87
7 Biliary radiomanometry as an investigative
tool in biliary tract disease
J.D. McCarthy 9S
Discussion 102
8 The role of glucagon in the treatment ofbiliary
tract pathology
F. Paul 107
Discussion 117
9 Hepatotrophic effects of insulin and glucagon
and their potential role in the treatment of
hepatic failure
N.A. Volpicelli 121
Discussion 130
General discussion
Chairman: .P rofessor A. Oriol Bosch 135
Index 143
6
List of Participants
A.L. Baker L. Kreel
Department ofM edicine Division ofR adiology
University ofC hicago Clinical Research Centre and
Chicago, IL 60637 Northwick Park Hospital
USA Harrow HAl 3 UJ
United Kingdom
B. Ek
Section ofG astroenterology
J.D. McCarthy
Department of Medicine
Department ofS urgery
University of Umea
University ofN ew Mexico
Umea
Schoal afM edicine
Sweden
Albuquerque, NM 87123
USA
A. Gomez-Pan
Department ofE xperimental
Endocrinology
J.Myren
Medical School oft he
Department ofG astroenteroLogy
Universidad Complutense
UllevaL Hospital
Madrid
Oslo 1
Spain
Norway
J.B.Jaspan
Department ofM edicine F. Paul
Section ofE ndocrinology gentre afI nternal Medicine
University ofC hicago Justus Liebig University
Chicago, IL 60637 Giessen
USA West Germany
7
Glucagon in Gastroenterology
E. Pearce N.A. Volpicelli
The London Hospital Medical Gastrointestinal Section
College Lovelace Medical Center
Academic Unit ofG astroenterology Albuquerque, NM 87123
The London Hospital USA
London E1 1 BB
United Kingdom D.L. Wingate
The London Hospital Medical
M.-J.
Treffot College
Hopital La Conception Academic Unit ofG astroenterology
Centre de Gastroenterologie The London Hospital
Marseille London Ell BB
France United Kingdom
8
Preface
It was with very much pleasure that I accepted the invitation to
chair this workshop on Glucagon in Gastroenterology. Not least
among the reasons for my accepting was the fact that it would
get me out from behind my administrator's desk at the univer
sity and enable me to spend what promised to be a few refreshing
hours in a field where so much is apparently happening.
Another reason for my accepting was the attractiveness of
the format planned for the workshop. It was to be a working
event. The programme had been carefully planned to ensure
that all aspects of the subject were covered and a very tight
schedule was drawn up for we had to deal with the whole field in
just one day. There was to be a small, truly international, list of
participants, and, apart from those presenting papers, only two
or three specially invited observers were to be present. Above
all, perhaps, was the fact that the meeting was to be a multi
disciplinary one. This final point did indeed prove to be an
extre~ely valuable one, for, as one of the participants remarked
towards the end of the meeting: 'We all work busily away in our
own particular fields, but to a large extent i£ is only when we are
brought away and introduced to people working in other fields,
and find, to our surprise, that they are working on the same
things as us, that we know what the problems really are.'
The workshop took place in Madrid on 31 st May 1978. The
papers presented are published in this book, together with
edited versions of the discussions which followed each presenta
tion. Two exceptions occur, in that there is no discussion after
the paper of Dr Gomez-Pan nor after that of Dr Treffot. I have to
explain that, in the first case, Dr Gomez-Pan stepped into the
9
Glucagon in Gastroenterology
breach at literally overnight notice to take the place of the
scheduled speaker who was unable to attend. The discussion
which followed his presentation was not really pertinent to the
paper which he subsequently wrote for publication, and so is not
included. As far as Dr Treffot is concerned, at the very last
minute she too was unfortunately unable to travel to Madrid.
Her paper was read to the meeting, but, as the author was not
present to answer questions, no real discussion was possible.
As chairman of the workshop I had far less work to do than
anyone else, which is another appealing aspect of being chair
man. One thing I am allowed to do though is to extend the
thanks, and this I gladly do. First of all, and most sincerely, I
thank all those who came to Madrid to participate in this
workshop, both those who presented papers, and those who gave
us the benefit of their opinions and experience during the
discussion sessions. My thanks are also extended to Dr Jose
Picazo and to Pamela Freebody who gathered all the material
together, edited the discussions, and arranged for the publica
tion of this book, and to Dr D. R. Owens for his assistance and
helpful criticism in the editing process. Finally, and most
especially, they are extended to Dr John Mumford of Novo
Industri A/S, Denmark, who arranged for his company to
organize and sponsor the whole event.
A. Oriol Bosch
Dean, Madrid U niversidad
Complutense, Medical School
10
1 Glucagon as a Drug
A. Gomez-Pan, G. BlesaMalpica,
M.D. Rodriguez Arnao and A. Oriol Bosch
The importance of glucagon as a hormone involved in nutrient
homeostasis is rapidly growing. Its role in physiology and patho
physiology has recently been the subject of some excellent
reviews.I-4 In addition, however, glucagon has a number of
pharmacological properties which are not necessarily related to
its physiological role. A review of the clinical applications of
glucagon as a drug forms the basis of this introductory chapter.
ACTIONS ON GROWTH HORMONE SECRETION
Roth and his co-workers first reported in 1963 that the ad
ministration of glucagon is followed by a rise in plasma growth
hormone (GH) levels.5 At that time the mechanism of glucagon
induced GH release was a rather controversial issue. The rise in
GH levels was thought to be due to the stress of nausea often
caused by glucagon,6 but this seems unlikely since not all
responders become nauseated after the injection. Most authors
now accept that the release ofGH after glucagon is independent
of the blood sugar changes,7 8 but some argue that a fall in blood
glucose levels after the initial rise is esse!ltial for a positive GH
response.9 Mitchell and his colleagues10 described a test for
assessing GH reserve by administering 1 mg of glucagon sub
cutaneously and blood sampling for GH and glucose estimations
both before and at intervals for 3h afterwards. Normal suqjects
are expected to exceed basal GH levels by at least 6ng/m1l3 h
post glucagon. Cain et ai.,l1 trying various routes of ad
ministration, found the subcutaneous test to be the most
reliable. In their hands the glucagon test yielded less false
11
