Peptide education
Secretin
Human secretin · ChiRhoStim
Secretin is a hormone released by the small intestine. A synthetic human secretin medicine can stimulate pancreatic secretions during certain diagnostic procedures.
ChiRhoStim is an intravenous diagnostic medicine. Its U.S. label describes pancreatic function testing, gastrinoma testing, and identification of papillae during ERCP. The dose varies by purpose, and pediatric safety and effectiveness have not been established.
Overview
Quick answer
ChiRhoStim is used to assist diagnosis or a procedure, not to treat the underlying pancreatic condition. Its label lists ERCP-related use; the secretin-enhanced MRCP study is a separate imaging context.
What is secretin used to test?
ChiRhoStim can stimulate pancreatic secretions for exocrine function assessment or gastrin release to assist gastrinoma diagnosis.
Is it also used during ERCP?
The label includes stimulation of pancreatic fluid to help identify the ampulla of Vater and accessory papilla during ERCP.
Is the dose the same for every test?
No. The label specifies 0.2 mcg per kg for pancreatic secretion and ERCP uses, and 0.4 mcg per kg for gastrinoma testing.
Does better imaging mean secretin treats pancreatitis?
No. A prospective MRCP study evaluated detection of duct abnormalities, not treatment of pancreatitis.
Evidence
Evidence snapshot
The label covers pancreatic exocrine testing, gastrinoma testing, and a specific ERCP procedure aid.
A small crossover study reported more successful minor-duct cannulations with secretin than placebo.
Secretin-enhanced images had higher sensitivity for duct abnormalities in the selected study population.
The label does not establish safety and effectiveness in pediatric patients.
Claims
Common claims vs evidence
| Claim | Human evidence | Verdict |
|---|---|---|
| Secretin is a treatment for pancreatitis. | The cited imaging study compared MRCP images before and after secretin in patients evaluated for pancreatitis. | Better detection of duct abnormalities does not establish a treatment effect on the disease. |
| The gastrinoma dose is the same as the pancreatic-function dose. | The ChiRhoStim label specifies 0.4 mcg per kg for gastrinoma testing and 0.2 mcg per kg for pancreatic secretion testing. | The labeled dose depends on the diagnostic purpose. |
| All secretin imaging studies are the same as the labeled ERCP use. | The label describes identification of papillae during ERCP. The cited prospective study used secretin-enhanced MRCP with ERCP as the reference. | ERCP and MRCP are different procedures; the MRCP finding should be identified as study evidence. |
Bottom line
Main takeaway
Secretin makes some digestive secretions easier to measure or observe during a clinical test.
Medicines and clinical conditions can affect the response, so the procedure and its interpretation need specialist oversight.
Keep the ERCP label study separate from the prospective baseline-controlled MRCP imaging study.
Identity
What it is
Human secretin is a 27-amino-acid hormone. ChiRhoStim contains synthetic human secretin as a powder for reconstitution.
Secretin stimulates pancreatic fluid and bicarbonate secretion; in gastrinoma testing, a rise in gastrin helps inform diagnosis.
Use context
Routes, doses, and cycle patterns
ChiRhoStim is given intravenously for diagnostic testing; the labeled dose depends on the procedure.
Human studies and product labels
Pancreatic exocrine function testing
- Purpose
- Stimulate secretions, including bicarbonate, to aid diagnosis
- Context
- U.S. ChiRhoStim label
- Route
- Intravenous over one minute
- Amount
- 0.2 mcg per kg of body weight
- Frequency
- Single test dose
The test requires an established collection and interpretation method. Pediatric safety and effectiveness have not been established.
Gastrinoma testing
- Purpose
- Stimulate gastrin secretion to aid diagnosis
- Context
- U.S. ChiRhoStim label
- Route
- Intravenous over one minute
- Amount
- 0.4 mcg per kg of body weight
- Frequency
- Single test dose
The amount is twice the labeled weight-based dose for the pancreatic secretion indication.
ERCP procedure aid
- Purpose
- Help identify the ampulla of Vater and accessory papilla
- Context
- U.S. ChiRhoStim label
- Route
- Intravenous over one minute
- Amount
- 0.2 mcg per kg of body weight
- Frequency
- Single procedure dose
In a label-described crossover study, patients had pancreas divisum and were undergoing ERCP.
What varies
- ChiRhoStim is supplied in 16 mcg and 40 mcg single-dose vials; the reconstituted concentrations differ by vial strength.
- Anticholinergics and acid-suppressing medicines can affect testing. The label gives test-specific instructions; patients should not change medicines without their clinician.
Research
Research evidence
The ChiRhoStim label describes small diagnostic studies. A separate prospective MRCP study assessed detection of pancreatic duct abnormalities using ERCP as its reference.
| Study / evidence area | Population | Design | Product context | Main outcome | Limitations | Weight |
|---|---|---|---|---|---|---|
| Secretin-assisted ERCP in pancreas divisum | 24 patients with pancreas divisum undergoing ERCP | Randomized placebo-controlled crossover study described in the label | ChiRhoStim 0.2 mcg per kg intravenously | Successful minor-duct cannulation in 16 of 24 with secretin versus 2 of 24 with placebo | Small selected procedural population; the outcome was cannulation, not disease treatment | Controlled procedure-specific evidence |
| Secretin-enhanced MRCP | 258 enrolled patients with acute or recurrent acute pancreatitis scheduled for ERCP | Multicenter baseline-controlled imaging study with blinded readers | Synthetic human secretin before repeat MRCP; ERCP was the reference procedure | All three radiologists reported higher sensitivity for duct abnormalities after secretin-enhanced imaging | Selected population scheduled for ERCP; 236 patients had evaluable ERCP results; diagnostic accuracy is not treatment benefit | Prospective diagnostic imaging evidence |
Cautions
Safety and unknowns
- Nausea, vomiting, flushing, and upset stomach were reported in the label's open-label study. Their frequency in other settings may differ.
- The label says pediatric safety and effectiveness have not been established, despite including some children in the broader safety data.
- Liver disease, anticholinergics, and acid-suppressing drugs can affect aspects of stimulation testing or its interpretation.
- The label reports no available clinical data for use during pregnancy and no data on its presence in human milk.
Product quality
Product identity and quality
ChiRhoStim is a prescription single-dose vial for reconstitution and intravenous use during diagnostic testing.
Diagnostic purpose
The gastrinoma test uses 0.4 mcg per kg, whereas the other listed procedures use 0.2 mcg per kg.
Vial strength
The 16 mcg and 40 mcg vials have different labeled reconstitution concentrations.
Mechanism
How it is proposed to work
Secretin prompts the pancreas to release fluid containing bicarbonate, which can be collected or observed during testing.
Gastrinoma cells can respond to secretin with increased gastrin release, providing a separate diagnostic signal.
FAQ
Common questions
Does secretin treat pancreatitis?
The ChiRhoStim label describes diagnostic uses. The cited MRCP study assessed pancreatic duct imaging, not treatment of pancreatitis.
Details
Technical details
Sources
References
- 1.
DailyMed. ChiRhoStim prescribing information
Human secretin diagnostic indications, purpose-specific doses, pediatric limitation, and safety.
- 2.
doi:10.1053/j.gastro.2014.05.035 PMID:24906040 NCT00660335
Prospective baseline-controlled MRCP imaging study with ERCP as the reference.