Assessment Of Pancreatic Function Research Articles

Assessment of Pancreatic Function and Quality of Life beyond the Initial Year after Pancreaticoduodenectomy

Assessment of Pancreatic Function and Quality of Life beyond the Initial Year after Pancreaticoduodenectomy

Defining the Accuracy of Secretin Pancreatic Function Testing in Patients With Suspected Early Chronic Pancreatitis

The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through secretin pancreatic function testing (SPFT) has been advocated in this setting, but its diagnostic accuracy is not fully known. This was a retrospective review of patients who received SPFT at our tertiary care institution between January 1995 and December 2008 for suspected chronic pancreatitis. For all patients, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology. Patients were then categorized as "true positive" or "true negative" for chronic pancreatitis based on follow-up imaging or histologic evidence. In all, 116 patients underwent SPFT. Of the 27 patients who tested positive, 7 were lost to follow-up. Of the remaining 20 SPFT-positive patients, 9 (45%) developed radiologic or histologic evidence of chronic pancreatitis after a median of 4 years (1-11 years). Of the 89 patients who had negative SPFT testing, 19 were lost to follow-up. Of the remaining 70 patients, 2 were eventually diagnosed with chronic pancreatitis based on subsequent imaging/histology after a median follow-up period of 7 years (3-11 years). The sensitivity of the SPFT in diagnosing chronic pancreatitis was 82% with a specificity of 86%. The positive predictive value (PPV) of chronic pancreatitis was 45% with a negative predictive value (NPV) of 97%. In patients with suspected early chronic pancreatitis and normal pancreatic imaging, SPFT is highly accurate at ruling out early chronic pancreatitis with a NPV of 97%.

Chronic pancreatitis: from guidelines to clinical practice

Introduction The paucity of specific standardized criteria leads to uncertainties in clinical practice regarding the management of chronic pancreatitis (CP).Objectives This paper reports some of the systematic guidelines for the diagnosis and treatment of CP recently elaborated by an Italian multicenter study group. We review recommendations on clinical and nutritional aspects of the disease, assessment of pancreatic function, treatment of exocrine pancreatic failure and secondary diabetes, treatment of pain, and prevention of painful relapses. The review also looks at the role of endoscopy in the management of pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications; the appropriate use of various imaging techniques, including endoscopic ultrasound; and the indications for and techniques used in surgical management of CP.

226 Fibrosis Reduces Severity of Acute Attacks in Chronic Pancreatitis (CP) by Preventing Peri-Fat Acinar Necrosis (PFAN) Around Fat Necrosis (FN)

Background: The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through collection of duodenal fluid following secretin stimulation testing (SST) has been advocated in this setting. The diagnostic accuracy of SST in detecting early chronic pancreatitis is not fully known. Aim: To determine if subjects with suspected chronic pancreatitis and abnormal SST subsequently develop histologic or radiographic changes of chronic pancreatitis compared with those with normal SST. Methods: We performed a retrospective review of subjects who received SST at our institution between January 1995 and December 2007 for suspected chronic pancreatitis. All had normal cross sectional and endoscopic imaging of the pancreas prior to SST. A positive test was defined as a peak bicarbonate level of <75mEq/L in duodenal fluid collected over 1 hr following administration of IV secretin. For all subjects, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology from surgical specimens. Subjects were contacted by phone if there was insufficient follow-up by medical records. Patients were then categorized as a ‘true positive', or a ‘true negative' for chronic pancreatitis based on follow-up evidence, allowing for the calculation of sensitivities, specificities, negative predictive value (NPV) and positive predictive value (PPV). Results: 87 subjects with suspected early chronic pancreatitis who underwent SST were reviewed. 60 tested negative and 27 tested positive. Of the 27 patients who tested positive (76% female, average age of 46.6 years), 4 were lost to follow-up. Of the remaining 23 SST positive subjects, 11(48%) developed radiologic or histologic evidence of chronic pancreatitis after a median of 3 years (1-9 years). There was no difference in average or median peak bicarbonate levels (60 mEq/L and 65 mEq/L, respectively) between the group of subjects that developed imaging or histologic evidence of chronic pancreatitis and the group that did not. Of the 60 subjects who tested negative (67% female, average age of 45 years), 13 were lost to follow-up. Of the remaining 47, only one subject was eventually diagnosed with chronic pancreatitis based on subsequent imaging (p<0.001) after a median follow-up period of 6 years (3-11 years). The sensitivity of the SST in diagnosing chronic pancreatitis was 92% with a specificity of 79%; PPV of chronic pancreatitis was 47.8% with a NPV of 97.8%. Conclusions: In imaging-negative patients with suspected chronic pancreatitis, SST is a sensitive predictor of early chronic pancreatitis as well as a highly accurate test for ruling out early chronic pancreatitis with a NPV of 97.8%.

223 Long Term Follow-up of Patients With Suspected Early Chronic Pancreatitis to Determine the Diagnostic Accuracy of the Secretin Pancreatic Stimulation Test

Background: The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through collection of duodenal fluid following secretin stimulation testing (SST) has been advocated in this setting. The diagnostic accuracy of SST in detecting early chronic pancreatitis is not fully known. Aim: To determine if subjects with suspected chronic pancreatitis and abnormal SST subsequently develop histologic or radiographic changes of chronic pancreatitis compared with those with normal SST. Methods: We performed a retrospective review of subjects who received SST at our institution between January 1995 and December 2007 for suspected chronic pancreatitis. All had normal cross sectional and endoscopic imaging of the pancreas prior to SST. A positive test was defined as a peak bicarbonate level of <75mEq/L in duodenal fluid collected over 1 hr following administration of IV secretin. For all subjects, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology from surgical specimens. Subjects were contacted by phone if there was insufficient follow-up by medical records. Patients were then categorized as a ‘true positive', or a ‘true negative' for chronic pancreatitis based on follow-up evidence, allowing for the calculation of sensitivities, specificities, negative predictive value (NPV) and positive predictive value (PPV). Results: 87 subjects with suspected early chronic pancreatitis who underwent SST were reviewed. 60 tested negative and 27 tested positive. Of the 27 patients who tested positive (76% female, average age of 46.6 years), 4 were lost to follow-up. Of the remaining 23 SST positive subjects, 11(48%) developed radiologic or histologic evidence of chronic pancreatitis after a median of 3 years (1-9 years). There was no difference in average or median peak bicarbonate levels (60 mEq/L and 65 mEq/L, respectively) between the group of subjects that developed imaging or histologic evidence of chronic pancreatitis and the group that did not. Of the 60 subjects who tested negative (67% female, average age of 45 years), 13 were lost to follow-up. Of the remaining 47, only one subject was eventually diagnosed with chronic pancreatitis based on subsequent imaging (p<0.001) after a median follow-up period of 6 years (3-11 years). The sensitivity of the SST in diagnosing chronic pancreatitis was 92% with a specificity of 79%; PPV of chronic pancreatitis was 47.8% with a NPV of 97.8%. Conclusions: In imaging-negative patients with suspected chronic pancreatitis, SST is a sensitive predictor of early chronic pancreatitis as well as a highly accurate test for ruling out early chronic pancreatitis with a NPV of 97.8%.

224 Bone Mineral Metabolism in Patients With Alcohol Related and Idiopathic Chronic Pancreatitis

Background: The diagnosis of chronic pancreatitis in patients with characteristic symptoms but normal pancreatic imaging is challenging. Assessment of pancreatic function through collection of duodenal fluid following secretin stimulation testing (SST) has been advocated in this setting. The diagnostic accuracy of SST in detecting early chronic pancreatitis is not fully known. Aim: To determine if subjects with suspected chronic pancreatitis and abnormal SST subsequently develop histologic or radiographic changes of chronic pancreatitis compared with those with normal SST. Methods: We performed a retrospective review of subjects who received SST at our institution between January 1995 and December 2007 for suspected chronic pancreatitis. All had normal cross sectional and endoscopic imaging of the pancreas prior to SST. A positive test was defined as a peak bicarbonate level of <75mEq/L in duodenal fluid collected over 1 hr following administration of IV secretin. For all subjects, medical records were reviewed for evidence of subsequent development of chronic pancreatitis by imaging and/or pathology from surgical specimens. Subjects were contacted by phone if there was insufficient follow-up by medical records. Patients were then categorized as a ‘true positive', or a ‘true negative' for chronic pancreatitis based on follow-up evidence, allowing for the calculation of sensitivities, specificities, negative predictive value (NPV) and positive predictive value (PPV). Results: 87 subjects with suspected early chronic pancreatitis who underwent SST were reviewed. 60 tested negative and 27 tested positive. Of the 27 patients who tested positive (76% female, average age of 46.6 years), 4 were lost to follow-up. Of the remaining 23 SST positive subjects, 11(48%) developed radiologic or histologic evidence of chronic pancreatitis after a median of 3 years (1-9 years). There was no difference in average or median peak bicarbonate levels (60 mEq/L and 65 mEq/L, respectively) between the group of subjects that developed imaging or histologic evidence of chronic pancreatitis and the group that did not. Of the 60 subjects who tested negative (67% female, average age of 45 years), 13 were lost to follow-up. Of the remaining 47, only one subject was eventually diagnosed with chronic pancreatitis based on subsequent imaging (p<0.001) after a median follow-up period of 6 years (3-11 years). The sensitivity of the SST in diagnosing chronic pancreatitis was 92% with a specificity of 79%; PPV of chronic pancreatitis was 47.8% with a NPV of 97.8%. Conclusions: In imaging-negative patients with suspected chronic pancreatitis, SST is a sensitive predictor of early chronic pancreatitis as well as a highly accurate test for ruling out early chronic pancreatitis with a NPV of 97.8%.

Chronic pancreatitis: from guidelines to clinical practice

Summary Introduction The paucity of specific standardized criteria leads to uncertainties in clinical practice regarding the management of chronic pancreatitis (CP). Objectives This paper reports some of the systematic guidelines for the diagnosis and treatment of CP recently elaborated by an Italian multicenter study group. We review recommendations on clinical and nutritional aspects of the disease, assessment of pancreatic function, treatment of exocrine pancreatic failure and secondary diabetes, treatment of pain, and prevention of painful relapses. The review also looks at the role of endoscopy in the management of pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications; the appropriate use of various imaging techniques, including endoscopic ultrasound; and the indications for and techniques used in surgical management of CP.

Computed Tomography Reflected Endocrine Function of the Pancreas

Backgrouns/AimsThere are few studies about the assessment of pancreatic function using computed tomography (CT) volumetry. In this study, we examined the correlation between CT volumetry and endocrine parameters (blood glucose and HbA1c) of the pancreas. MethodsA total of 68 patients underwent enhanced CT for pancreatic disease from January to December in 2008. In particular, we analyzed the correlation of diabetic status and pancreatic CT parameters at 1 year after pancreatoduodenectomy in 32 patients. CT parameters including volume, volume/body weight, arterial phase density, the arterial phase to portal phase density ratio (A/P ratio) of the pancreas, and size of pancreatic duct were also analyzed. Correlation between CT parameters and diabetic status was analyzed preoperatively and postoperatively by ANOVA test. ResultsThe preoperative diabetic status and parameters correlated well with arterial phase density (p = 0.004), A/P ratio, and pancreatic duct size (p < 0.0001). In the patients who underwent pancreatectomy, two out of 25 patients without preoperative diabetes mellitus (DM) had DM, and two out of seven patients with preoperative DM recovered from DM. Postoperative CT parameters correlated with the DM status 1 year after pancreatectomy. ConclusionCT is a useful modality for evaluation of the pancreatic endocrine function and could be used for the prediction of postoperative diabetic outcome.

Italian consensus guidelines for chronic pancreatitis

This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery.

Technology Insight: applications of MRI for the evaluation of benign disease of the pancreas

This article reviews the role of MRI in the evaluation of benign pancreatic disease. Although MRI and magnetic resonance cholangiopancreatography (MRCP) are most often used to evaluate the liver and bile duct, technical advances such as the use of secretin stimulation also allow for high-quality imaging of the pancreas and pancreatic ductal system. Secretin-stimulated MRCP (S-MRCP) can aid the diagnosis of acute and chronic pancreatitis, and delineate ductal pathology such as benign strictures and duct leaks. There seems to be a role for S-MRCP in the assessment of pancreatic function and (possibly) sphincter of Oddi dysfunction. When endoscopic or surgical therapy is planned, S-MRCP can help to establish a diagnosis as well as offer a 'road map' to guide therapy. S-MRCP is noninvasive and almost entirely without risk to the patient, which gives it a distinct advantage over traditional endoscopic methods of diagnosis for conditions such as pancreas divisum and other ductal pathology. The information provided by S-MRCP, obtained before endoscopic or surgical therapy is attempted, can assist the patient and physician in making a fully informed decision with regard to the risks and probable benefits of any planned intervention.

Indirect Pancreatic Function Tests in Children

Indirect Pancreatic Function Tests in Children

Proper usage of pancreatic enzymes.

With the recognition of the close link between nutritional status and pulmonary function in cystic fibrosis (CF), treatment and prevention of malnutrition have become a major focus in the modern therapeutic approach for patients with CF. Thereby, pancreatic enzyme replacement therapy plays a central role. This article reviews key publications on important aspects of pancreatic enzyme replacement therapy contained in the literature over the last 12 months. New insights into the pathogenesis of exocrine pancreatic disease, efficacy and dosing of pancreatic enzyme preparations, occurrence of fibrosing colonopathy, enzyme replacement in the context of enteral nutrition, and assessment of pancreatic function are addressed.

Pancreatic function tests: when to choose, what to use.

Although techniques for high-resolution imaging of the pancreas are constantly being improved, the evaluation of pancreatic function remains crucial for the workup of pancreatic diseases. More than 20 direct and indirect tests are available for the assessment of pancreatic function. Measurement of fecal elastase-1 is recommended as the most suitable test for the initial assessment of pancreatic function. Among other techniques, the pancreolauryl test, and alternatively the BT-PABA (N-benzoyl-L-tyrosyl-p-aminobenzoic acid) or the (13)C-mixed-triglyceride test, yield the best sensitivity and specificity. Nevertheless, all indirect tests are of limited value in patients with mild to moderate impairment of pancreatic function. In these patients, the secretin-caerulein test remains the gold standard.

Fecal Isoamylase Activity in Patients with Pancreatic Diseases

Fecal isoamylase activity was studied in 93 consecutive patients (26 in the recovery stage of acute pancreatitis, 24 with chronic pancreatitis, 13 with pancreatic cancer, and 30 with other gastrointestinal diseases) and compared with fecal chymotrypsin activity and the results of the secretin test. Seventy-six healthy subjects were studied as controls. Both pancreatic (p)-type and salivary (s)-type isoamylase activities in stool were determined by inhibitor assay as well as cellulose acetate electrophoresis. The mean fecal amylase activity in healthy subjects was 757 +/- 88 IU/g (p-type isoamylase: 77 +/- 2%, s-type isoamylase: 23 +/- 2%). There was a good correlation between fecal p-type isoamylase and chymotrypsin activities (r = 0.625, p less than 0.001). Fecal p-type isoamylase activity in patients with chronic pancreatitis and pancreatic cancer was significantly lower than in healthy subjects (p less than 0.001). Patients with moderate and severe exocrine pancreatic insufficiency as determined by the secretin test had significantly lower fecal p-type isoamylase activity. Daily fat intake did not affect fecal amylase or isoamylase activities. Fecal s-type isoamylase activity in patients with hypoacidity was significantly higher than in patients with hyperacidity, but no difference in fecal p-type isoamylase activity was observed. It is concluded that analysis of fecal isoamylase activity is useful in the assessment of pancreatic function.

Assessment of pancreatic function in screened infants with cystic fibrosis

Previously we have reported that 37% of infants with cystic fibrosis diagnosed by neonatal screening with the dried blood spot immunoreactive trypsin assay have pancreatic sufficiency. However, 34 of the 78 infants had pancreatic function tests an average 2.3 years after diagnosis, thus it was possible that the percentage with neonatal pancreatic sufficiency was underestimated, due to the loss of pancreatic function with time in some infants. To assess this hypothesis we have assessed pancreatic function at the time of diagnosis in a further 20 infants since the completion of the previous study. Results of fecal fat determinations and/or pancreatic stimulation tests indicate that 10 (50%) of these infants have pancreatic sufficiency. Combining these results with those of the previous study, 31 of 64 patients (48%) have pancreatic sufficiency at this early age. We have also monitored the progression of pancreatic disease in the 39 patients with pancreatic sufficiency recognized to date. Eleven have developed pancreatic insufficiency and require enzyme replacement therapy. Five others have shown further improvement of colipase secretion with age. We conclude that the dried blood immunoreactive trypsin screening program for cystic fibrosis does recognize patients with pancreatic sufficiency, and at diagnosis nearly half the patients are in this category. To date, 28% of patients with pancreatic sufficiency have demonstrated a variable decline in pancreatic function with age.

Assay of human pancreatic lipase in biological fluids using a non-competitive enzyme immunoassay

A sandwich enzyme immunoassay has been developed for human pancreatic lipase using polystyrene balls coated with specific IgG as the first antibody and peroxidase-labelled IgG as the second antibody. The detection limit was 0.5 μg/1. Good parallelism was observed with the curves obtained from standard lipase and lipase present in serum, pancreatic juice and duodenal contents, demonstrating that the assay may be used to measure the level of the protein in different biological fluids. Mean values of lipase in human sera were 12.3 ± 6.8 μg/1 in adults and 4.5 ± 2.7 in newborns. In all cases a good correlation was found in serum between the catalytic activity and the enzyme immunoassay. Lipase is detectable in amniotic fluids at the 18th week of pregnancy but at a very low level (0.95 ± 0.32 μg/1). In pancreatic juices, lipase concentration was 14.6% of the total protein content. A study on cystic fibrosis patients showed a poor correlation between blood pancreatic lipase concentration and fat malabsorption underlying the difficulty in assessing pancreatic function by the measurement of serum pancreatic enzymes. The use of the lipase assay in duodenal contents would permit better assessment of pancreatic function in patients presenting a severe or borderline defect in fat digestion and absorption.

Serum lipase and assessment of pancreatic function.

Journal Article Serum lipase and assessment of pancreatic function. Get access G Lindstedt, G Lindstedt Search for other works by this author on: Oxford Academic Google Scholar R Stockbrügger, R Stockbrügger Search for other works by this author on: Oxford Academic Google Scholar D Runsteen, D Runsteen Search for other works by this author on: Oxford Academic Google Scholar A F Kilander, A F Kilander Search for other works by this author on: Oxford Academic Google Scholar U Armbrecht U Armbrecht Search for other works by this author on: Oxford Academic Google Scholar Clinical Chemistry, Volume 32, Issue 5, 1 May 1986, Page 898, https://doi.org/10.1093/clinchem/32.5.898a Published: 01 May 1986

Plasma Immunoreactive Anionic Pancreatic Trypsin in Cystic Fibrosis

SummaryPrevious data from this laboratory have shown good correlation between plasma cationic trypsin(ogen) and levels of pancreatic function in older cystic fibrosis (CF) patients with and without malabsorption. In the present study a radioimmunoassay for human anionic trypsin(ogen) has been employed in the assessment of pancreatic function in older patients with CF. Immunoreactive anionic trypsin(ogen) levels correlated poorly with pancreatic function due to an apparent elevation of this enzyme in many older CF patients with malabsorption (CF + M). When plasma from three older CF + M patients is examined for the molecular size of the apparent immunoreactive material detected, no free anionic trypsinogen is observed. Instead, a broad peak of apparent immunoreactive material appears in the gammaglobulin region. However, only free anionic trypsinogen could be detected in plasma from two CF patients without malabsorption (CF ‐ M), who had not received pancreatic enzyme supplements. It appears possible that a human plasma immunoglobulin G (IgG) to porcine pancreatic enzyme in the CF + M patients might interfere in the assay by binding TLCK‐anionic trypsin tracer. It is unclear why such an effect does not appear to occur in the cationic trypsin(ogen) assay. The results of the current study suggest that, for assessment of pancreatic insufficiency in CF, the radioimmunoassay for cationic trypsin(ogen) is more useful than the presently available radioimmunoassay for the anionic form.

Plasma immunoreactive anionic pancreatic trypsin in cystic fibrosis.

Previous data from this laboratory have shown good correlation between plasma cationic trypsin(ogen) and levels of pancreatic function in older cystic fibrosis (CF) patients with and without malabsorption. In the present study a radioimmunoassay for human anionic trypsin(ogen) has been employed in the assessment of pancreatic function in older patients with CF. Immunoreactive anionic trypsin(ogen) levels correlated poorly with pancreatic function due to an apparent elevation of this enzyme in many older CF patients with malabsorption (CF + M). When plasma from three older CF + M patients is examined for the molecular size of the apparent immunoreactive material detected, no free anionic trypsinogen is observed. Instead, a broad peak of apparent immunoreactive material appears in the gammaglobulin region. However, only free anionic trypsinogen could be detected in plasma from two CF patients without malabsorption (CF - M), who had not received pancreatic enzyme supplements. It appears possible that a human plasma immunoglobulin G (IgG) to porcine pancreatic enzyme in the CF + M patients might interfere in the assay by binding TLCK--anionic trypsin tracer. It is unclear why such an effect does not appear to occur in the cationic trypsin(ogen) assay. The results of the current study suggest that, for assessment of pancreatic insufficiency in CF, the radioimmunoassay for cationic trypsin(ogen) is more useful than the presently available radioimmunoassay for the anionic form.

Radioimmunoassay of trypsin. A new aid in the assessment of pancreatic function.

This review describes the development and application of a novel test to determine levels of human immunoreactive trypsin, an enzyme produced solely by the pancreas, in biological fluids. Being organ-specific, the assay of immunoreactive trypsin should be an ideal marker of pancreatic function, and this is supported by the results of a number of clinical and research investigations. Use of this assay in studies of chronic pancreatitis, juvenile-onset diabetes, and cystic fibrosis has yielded much valuable data, and it is expected that further research will lead to an improved understanding of these and other conditions associated with the pancreas in health and disease.