What is the role of cholecystokinin (CCK) releasing factor (CRF) in the treatment of chronic pancreatitis?

Updated: Jul 15, 2019
  • Author: Jason L Huffman, MD; Chief Editor: BS Anand, MD  more...
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CCK releasing factor (CRF) typically is secreted into the duodenum. During the interdigestive period, proteolytic enzymes within the pancreatic juice rapidly degrade CRF. After a meal, the proteolytic enzymes are occupied with digesting dietary proteins, and enough CRF escapes to bind to duodenocytes, which stimulates CCK release, in turn stimulating pancreatic secretion.

In severe chronic pancreatitis with exocrine insufficiency, CCK levels may be high because proteolytic enzymes are low. When pancreatic enzyme supplements are administered in high doses, degradation of CRF is restored and the stimulus for CCK release is reduced.

This hypothesis is supported by one report that a CCK-receptor antagonist reduces pain in patients with chronic pancreatitis. The digestive products of a meal and the CCK-releasing factor stimulate CCK release from the duodenal mucosa. CCK acts directly on the pancreatic cells and indirectly through neural pathways to stimulate the pancreas. Through unknown mechanisms, such stimulation has been hypothesized to cause pain.

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