Diagnosis Of Exocrine Pancreatic Insufficiency Research Articles

Study on the exocrine pancreatic function by the oral administration of N-benzoyl-L-tyrosyl-para-aminobenzoic acid

N-benzoyl-L-tyrosyl-p-aminobenzoic acid (Bz-ty-PABA) was orally administered to 11 controls, 10 patients with chronic pancreatitis, 7 patients with diabetes mellitus and 6 patients with liver cirrhosis. The cumulative 6 h recovery rate of PABA in the urine was significantly lower (P less than 0.005) in patients with chronic pancreatitis (49.1 + or - 10.1 percent), diabetes mellitus (50.4 + or - 20.4 percent) and liver cirrhosis (52.5 + or - 13.0 percent) than in the control group (79.5 + or - 12.0 percent) (mean + or -S.D.). This test is considered to be useful in the diagnosis of pancreatic exocrine insufficiency, especially in chronic pancreatitis. Patients with diabetes mellitus frequently has demonstrable abnormality of pancreatic exocrine function. Liver cirrhosis causing severe impairment of liver functions seemed to interfer with the elimination of PABA.

Serum Isoamylases in Chronic Pancreatitis

Serum isoamylases were quantitated separately in 15 patients with chronic pancreatitis. The mean activity of pancreatic isoamylase was 7 U/1 in the patients as compared to 88 U/1 in healtly controls, 8 of the patients completely lacked pancreatic isoamylase and the mean activity in the other was 15 U/1. Salivary isoamylase activities were moderately increased in the patients. Determination of the serum pancreatic isoamylase is a simple screening procedure that should be useful in the diagnosis of exocrine pancreatic insufficiency.

Use of substrate-coated barium sulfate tablets in the evaluation of digestive enzyme deficiency.

In vitro and in vivo studies determined the effect of digestive enzymes on substrate-coated barium sulfate tablets. Fragmentation of the barium tablet core was detected radiographically after enzymatic digestion of the substrate material occurred. Preliminary studies in humans suggest that such tablets may be used in the diagnosis of pancreatic exocrine insufficiency.

Diagnosis of pancreatic exocrine insufficiency by fecal chymotrypsin activity

Fourteen control subjects and 9 patients with severe pancreatic exocrine insufficiency were carefully studied to establish normal values of fecal chymotrypsin activity. Mean values for fecal chymotrypsin were uniformly abnormal in patients with pancreatic exocrine insufficiency. This study supports the previous literature in validating this test as a simple but effective method of screening patients with steatorrhea for the diagnosis of pancreatic exocrine insufficiency.

The value of the gelatin infusion test in the diagnosis of pancreatic exocrine insufficiency in patients with Billroth. II. Anastomoses.

Infusion of a test solution of gelatin into the proximal jejunum of 5 patients with Billroth II anastomoses with no suspected pancreatic disease produced a mean hydrolysis of 46.2%±4.9 SD of the infused gelatin to dialyzable peptides. In 3 patients with Billroth II anastomoses and chronic pancreatitis, the mean hydrolysis was 16%±2.6 SD. In 5 normal subjects and 7 patients with chronic pancreatitis and no prior surgery, the mean intraduodenal gelatin hydrolysis was 72.4%±9.1 SD and 9.0%±3.6 SD, respectively. These preliminary studies indicate that the gelatin infusion test may be of value in assessing pancreatic function in patients with Billroth II anastomoses in whom a secretin test cannot be performed.

Synthetic peptides in the diagnosis of exocrine pancreatic insufficiency in animals.

A new approach in the diagnosis of exocrine pancreatic insufficiency has been evaluated in animals. The method involves the oral administration of a chymotrypsin-labile peptide which contains p-aminobenzoic acid (PABA) as a tracer group. In the small bowel in the presence of chymotrypsin, the PABA is split from the peptide and is rapidly absorbed. The amount of PABA (as total aromatic amines) recovered in the urine during the six hours after the dose is used as an index of exocrine pancreatic function. The procedure has been shown to be reliable in detecting surgically induced pancreatic insufficiency in rats, swine, and dogs.

The measurement of faecal chymotrypsin: a screening test for pancreatic exocrine insufficiency.

SummaryEstimation of faecal chymotrypsin in a 24 hour stool specimen in a group of normal control subjects and patients with pancreatic exocrine insufficiency provides a useful, simple and practical screening test for the diagnosis of exocrine pancreatic insufficiency. Normal faecal chymotrypsin levels, especially in the presence of steatorrhoea, rule out the diagnosis of chronic pancreatitis as the cause of malabsorption. This test will not obviate the use of more sophisticated tests such as secretin stimulation but will enable the tests to be performed as confirmatory rather than screening procedures.

Fecal enzyme assay as an aid to the diagnosis of pancreatic exocrine insufficiency

Trypsin and chymotrypsin activity in feces were measured in various gastrointestinal disorders. The level of chymotrypsin activity was found to be a somewhat unreliable measurement of exocrine pancreatic function; low values for trypsin activity were of no diagnostic significance.