Gut hormone · pancreas diagnostics
The pancreas releases bicarbonate-rich fluid in response to secretin, a 27-amino-acid hormone produced in the lining of the small intestine1. ChiRhoStim, a synthetic peptide with exactly the human hormone's sequence, is approved by the FDA as a diagnostic agent1. It is given into a vein during tests of pancreas function, workups for gastrinoma, and endoscopic procedures on the pancreatic duct.
When stomach acid, fats or amino acids reach the first part of the small intestine, cells in its lining release secretin1. Secretin binds receptors on pancreatic duct cells and opens CFTR channels, producing a large volume of bicarbonate-rich fluid that helps neutralize stomach acid. Nerve pathways through the vagus nerve may also be involved1. Doctors use this response on purpose. Measuring the fluid and bicarbonate released after an injection shows how well the digestive (exocrine) pancreas works. A surge of gastrin after secretin points to a gastrin-making tumor. The extra flow of pancreatic juice also helps endoscopists find the duct openings during ERCP1. Secretin receptors also exist in the stomach, liver and colon1, and mouse and small human studies have linked secretin to brown fat4.
Its approved uses are diagnostic and are supported by human studies summarized in the label1. In a phase 3 study of 258 patients with pancreatitis, giving a synthetic human secretin during MRCP, an MRI scan of the bile and pancreatic ducts, picked up duct abnormalities with higher sensitivity than plain MRCP, using ERCP as the reference2. That imaging use is not on the US label. Secretin was once promoted for autism on the strength of anecdotes, but a Cochrane review of 16 randomized trials with over 900 children found no improvement in core autism features and advised against using it3. Newer work links secretin to brown fat. After mouse studies, a small randomized crossover trial in healthy men found intravenous secretin increased brown-fat glucose uptake and delayed the drive to eat again after a meal, without changing calorie intake4.
FDA-approved in 2004 as ChiRhoStim (ChiRhoClin). It is used to stimulate pancreatic secretion when diagnosing exocrine pancreas dysfunction, to stimulate gastrin release when diagnosing gastrinoma, and to help locate the pancreatic duct openings during ERCP1. Drugs@FDA also lists a porcine (pig) secretin product from the same company.
Per the FDA label, side effects in a 531-patient study were few: nausea, vomiting, flushing and upset stomach1. There are no listed contraindications. Results can be misleading. People who have had a vagotomy, have inflammatory bowel disease or take anticholinergic drugs may under-respond. Acid-reducing drugs (H2 blockers, PPIs) can raise gastrin and falsely suggest gastrinoma, and liver disease can mask pancreatic disease1. In the MRCP study, the events most often judged related were mild nausea, abdominal pain and flushing2.
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