Evaluation Of Exocrine Pancreatic Function Research Articles

Staging chronic pancreatitis with exocrine function tests: are we better?

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas evolving in progressive fibrotic disruption of the gland with exocrine and endocrine pancreatic insufficiency. Although imaging features of CP are well known, their correlation with exocrine pancreatic function tests are not obvious, particularly in the early stage of the disease. There are many clinical classification of CP, all suggested for better distinguish and manage different forms based on etiological and clinical factors, and severity of the disease. Recently, a new classification of CP has been suggested: the M-ANNHEIM multiple risk factor classification that includes etiology, stage classification and degree of clinical severity. However, more accurate determination of clinical severity of CP requires a correct determination of exocrine function of the pancreas and fecal fat excretion. Recently, Kamath et al. (2017) demonstrated that the evaluation of exocrine pancreatic function by acid steatocrit and fecal elastase-1 (EF-1) was helpful, but EF-1 was able to detect exocrine pancreatic insufficiency in more patients, upgrading some patients in higher stage of disease according to M-ANNHEIM classification. So, EF-1 is a more accurate test to determine exocrine pancreatic insufficiency and to stage chronic pancreatitis in the M-ANNHEIM classification. On the contrary, EF-1 determination shows low sensitivity in detecting exocrine pancreatic insufficiency in early stage of the disease.

Serum lipase level at postoperative day 1 is a more useful biomarker in objective evaluation of pancreatic exocrine function: a preliminary study

Serum lipase level at postoperative day 1 is a more useful biomarker in objective evaluation of pancreatic exocrine function: a preliminary study

5．Cystic fibrosisにおける膵機能の評価と治療

5．Cystic fibrosisにおける膵機能の評価と治療

Su1373 Evaluation of Pancreatic Exocrine Function in Patients With Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas

Su1373 Evaluation of Pancreatic Exocrine Function in Patients With Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas

Diagnostic accuracy of secretin-stimulated ultrasonography of the pancreas assessing exocrine pancreatic failure in cystic fibrosis and chronic pancreatitis

Objective. Volume output failure is a feature of decreasing exocrine pancreatic function. This parameter is assessed by secretin-stimulated MRI in several studies. Our purpose was to evaluate ultrasonography of the fluid in the descending duodenum and Wirsung duct (WD) after secretin stimulation as a measure of pancreatic fluid flow in patients expected to have severe output failure. Material and methods. We included subjects with chronic pancreatitis (CP), cystic fibrosis (CF) and a group of healthy controls in a prospective observation study. Transabdominal ultrasonography was performed before and during 15 min after secretin i.v. duodenal juice was collected by endoscopic short test (EST), and bicarbonate concentration measured. Patient groups were classified according to exocrine pancreatic function. Results. Pancreatic insufficient CF (CFI) patients and CP insufficient (CPI) patients showed less duodenal fluid filling compared to other groups (p < 0.001). Measures of the WD diameter could only identify the most severe failure in the CFI group (p < 0.001). Conclusion. Secretin-stimulated ultrasonography can be used to assess pancreatic fluid flow and may be combined with EST in the evaluation of exocrine pancreatic function. Fluid filling in the descending part of duodenum was the most accurate predictor of pancreatic insufficiency in both patient groups. The test demonstrated better diagnostic accuracy diagnosing exocrine pancreatic failure in the CF patients than in CP patients.

Case Report on a 21 Years Old Female Patient with Acute Pancreatitis in Cystic Fibrosis

Acute pancreatitis is a rare complication in patients with cystic fibrosis. We present a case of a young female with a history of bronchiectasis and Bartter syndrome, who was admitted in our hospital with an acute episode of pancreatitis. We had diagnosed the case as acute pancreatitis, but we did not have a cause for it. She denied drinking alcohol, or consuming drugs. Abdominal trauma was not reported. There was no stone or sludge in the gallbladder and biliary ducts, no malformation on the biliary ducts, and no dyslipidemia. As, the patient had a history of bronchiectasis and Bartter syndrome; we had to look for cystic fibrosis and therefore, we recommended the sweat test and genetic tests. The results obtained for heterozygote M 2183AA>G: 7T, 9T and the sweat test were positive. However, the genetic analyses of her parents could not be performed. We concluded the diagnosis as acute pancreatitis due to cystic fibrosis modifications. The patient was also pancreatic sufficient (the evaluation of exocrine pancreatic function was in normal ranges).

Su1235 Accuracy of a Short Version 13C-Mixed Triglyceride Breath Test for Evaluation of Pancreatic Exocrine Function

Su1235 Accuracy of a Short Version 13C-Mixed Triglyceride Breath Test for Evaluation of Pancreatic Exocrine Function

Indicación e interpretación de las pruebas funcionales pancreáticas

Pancreatic function tests have been used over decades for the diagnosis of chronic pancreatitis and the evaluation of exocrine pancreatic function in patients with known pancreatic disease. At present, only the endoscopy-based pancreatic function test and the magnetic resonance cholangiopancreatography after intravenous injection of secretin play a relevant role in the diagnosis of early chronic pancreatitis. Methods as the coefficient of fat absorption and the 13C-triglyceride breath test are mainly indicated for the diagnosis of pancreatic exocrine insufficiency and the evaluation of the efficacy of the pancreatic enzyme replacement therapy. Fecal elastase-1 quantification is still useful as an initial test in patients with clinical suspicion of chronic pancreatitis, whereas the use of fecal chymotrypsin is limited to the objective evaluation of patient's compliance to pancreatic enzyme replacement therapy.

Evaluation of exocrine pancreatic function and its possible consequences in patients with non-panceatic diabetes

Evaluation of exocrine pancreatic function and its possible consequences in patients with non-panceatic diabetes

Diffusion-Weighted MR Imaging in the Evaluation of Pancreatic Exocrine Function Before and After Secretin Stimulation

To evaluate diffusion weighted MR imaging before and after secretin stimulation in the assessment of pancreatic exocrine function in the setting of chronic pancreatitis. Nine patients with severe chronic pancreatitis and sixteen patients without chronic pancreatitis but with a history of chronic alcohol consumption were enrolled in the chronic pancreatitis and risk groups, respectively. Thirty-eight patients without any pancreatic disease or history of alcohol consumption were included in the control group. Diffusion weighted images were obtained before and after secretin administration in all patients. The peak ADC values and times were determined and intergroup differences were compared. A receiver operating characteristic curve (ROC) was used to identify the cutoff values of the peak ADC times for discrimination of control group from risk and chronic pancreatitis groups. In the control group, a peak increase in ADC value of 57-120% (median: 75%) was observed between 90 s and 4 min (median: 2 min) after administration of secretin (Pattern 1). In the risk group, in 13 patients, a peak increase of 52-150% was observed between 4 and 8 min (median: 7 min; Pattern 2). Peak times were significantly longer in risk group (p < 0.01). In three patients in the risk group, and in all patients in the chronic pancreatitis group, no ADC peak was observed within 10 min following secretin administration (Pattern 3). Using a peak time of 4 min as the cut-off value, a sensitivity of 100% and specificity of 94.7% were achieved in discriminating the control group from the combined risk and chronic pancreatitis groups. Diffusion-weighted MR imaging before and after secretin administration could yield clinically useful information for detecting pathophysiologic alterations in the setting of chronic pancreatitis.

Evaluation of Pancreatic Exocrine Function with the 13C Breath Test Using a Neutral Lipid Mixture

Purpose: Although there are examinations to evaluate pancreatic exocrine function, as measurement of fecal fat, these tests can be both cumbersome and unpleasant. Recently, the 13C breath test for lipid digestion and absorption using a neutral lipid mixture has been used as a non-invasive and simple method. However, comparisons have not been made between this breath test and other pancreatic exocrine functional tests. We evaluated pancreatic exocrine function using the 13C breath test with a neutral lipid mixture in comparison with both the bentiromide (B) and secretin(S) tests. Methods: Eighteen healthy controls, 11 patients with chronic pancreatitis without pancreatolithiasis (Group I) and 28 patients with chronic pancreatitis and pancreatolithiasis (Group II) were studied. Group II patients were examined by a 13C breath test a total of 81 times. Fasting patients and controls were administered orally 200 mg of a capsulated 13C-neutral lipid mixture with a test meal. Expired breaths were collected every 30 minutes for 8 hours and recovery rates of cumulative 13CO2 expired were calculated. At the same time, 16 control subjects and 11 group I patients were examined once by the B test. In group II, 23 patients were examined by the 13C breath test and B test two or more times in follow up (total 67 tests.) Twenty-four group I and II patients were administered the S test as well as the 13C breath test, for a total of 41 examinations. We used the amount of pure pancreatic juice for 25 minutes after administered 100 units of secretin as results of S test. We studied the correlation between results of the 13C breath test, B test, and S test. Results: Recovery rates of cumulative 13CO2 expired in the breath were 14.5±4.1% in controls, 12.8±4.0% in group I and 10.2±6.3% in group II. In group I, all cases were within mean±2SD of healthy controls. But in group II, 16 of 28 cases (25 of 81 tests) had a lower level of mean -2SD than healthy controls. The correlation coefficients for the breath test with the B test and S test were 0.375 and 0.404, respectively, and the p-values were 0.0002 and 0.0092, respectively. The results of the breath test correlated with those of the B and S tests. Conclusions: Many of those with calcified pancreatitis had deteriorated function for assimilated lipid compared with healthy controls. Results suggested that the breath test is comparable to the bentiromide and secretin tests and is useful as a test of pancreatic exocrine function.

Klinisch relevante Atemtests in der gastroenterologischen Diagnostik - Empfehlungen der Deutschen Gesellschaft für Neurogastroenterologie und Motilität sowie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen

H (2)- and (13)C-breath tests are valuable non-invasive diagnostic tools for gastroenterological diseases. H (2)-breath tests are clinically established for the diagnosis of carbohydrate intolerance resulting from malabsorption (H (2)-breath tests with lactose, fructose, saccharose, sorbitol), of bacterial overgrowth (glucose H (2)-breath test) and for measurement of orcoceal transit time (lactulose H (2)-breath test). The (13)C-urea breath test is regarded as the "gold standard" procedure for the diagnosis of Helicobacter pylori infection. Moreover, (13)C-breath tests for measurement of gastric emptying can be considered as clinically established, meanwhile. (13)C-breath tests for the evaluation of pancreatic exocrine function or liver function can also be used clinically; however, they currently offer no substantial advantage over other diagnostic procedures. A major disadvantage of all breath tests is that they lack standardization although modifications of the test meal or solution, of the test performance and of the evaluation of data may markedly influence the results. Thus, this article presents the recommendations of the German Society of Neurogastroenterology and Motility and of the German Society of Digestive and Metabolic Diseases for clinically relevant H (2)- and (13)C-breath tests. Indications for the examinations, the procedures to be followed, the analysis of the obtained data and the conclusions to be drawn are delineated. The literature on which the recommendations are based is reviewed. However, personal experience of the authors is also taken into account since numerous questions regarding optimal test performance are not clarified by adequate studies.

Value of magnetic resonance cholangiopancreatography with secretin stimulation in the evaluation of pancreatic exocrine function after pancreaticogastrostomy

The aim of this study was to assess the value of magnetic resonance cholangiopancreatography with secretin stimulation (secretin-MRCP) in evaluating the remnant pancreatic exocrine reserve after pancreaticogastrostomy with pancreaticoduodenectomy. Forty-three patients who had undergone pancreaticoduodenectomies and who were given pancreaticogastrostomies for reconstruction were studied. Dynamic MRCPs, using a half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence were obtained before and up to 10 min after secretin administration. The morphologic features and diameter of the main pancreatic duct were monitored and graded before and after secretin stimulation. The results were compared with those of endoscopic findings, secretin stimulation testing with a collection of pancreatic fluid, N-benzoyl- L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion testing, and fecal chymotrypsin concentration. The results of secretin-MRCP were classified into three distinct groups: a good-secretion group (group 1; n=22; 51%), a moderate-secretion group (group 2; n=10; 23%), and a poor-secretion group (group 3; n=11; 26%). This MRCP classification correlated significantly with the concentrations of the pancreatic enzymes p-type amylase, lipase, and trypsin in the gastric juice. The BT-PABA test value was 59.8% in group 1, 46.1% in group 2, and 46.5% in group 3, and was significantly higher in group 1 than in groups 2 or 3. The fecal chymotrypsin concentration was 20.5 U/g in group 1, 14.5 U/g in group 2, and 0.7 U/g in group 3, and there was a significant correlation between the MRCP classification and fecal chymotrypsin concentration. MRCP with secretin stimulation favorably reflected the presence of remnant pancreatic exocrine function. Therefore, secretin-MRCP is a feasible and effective follow-up examination method to evaluate remnant pancreatic exocrine function after pancreaticogastrostomy.

A Prospective Evaluation of Pancreatic Exocrine Function in Patients with Acute Pancreatitis: Correlation with Extent of Necrosis and Pancreatic Endocrine Insufficiency

Aims: The aim of this prospective study was to assess pancreatic exocrine function in patients recovering from a first attack of acute pancreatitis, and to evaluate its relationship to severity of attack, extent of pancreatic necrosis and severity of pancreatic endocrine insufficiency. Methods: Between December 2000 and November 2001, 23 patients were prospectively evaluated. Pancreatic exocrine function was measured by the faecal elastase-1 test and insufficiency was classified as moderately impaired or severely impaired. Pancreatic necrosis was determined by contrast-enhanced CT scan, and its extent was categorised according to Balthazar’s classification. The severity of pancreatic endocrine insufficiency was categorised according to insulin dependence. Attacks were classified as mild (n = 16) or severe (n = 7) according to the Atlanta criteria. Results: Pancreatic exocrine insufficiency was significantly more frequent in patients recovering from severe attacks than mild (n = 6, 86% vs. n = 2, 13%; p = 0.002), and in those who developed pancreatic necrosis or pseudocyst than those who did not (6 of 7 patients vs. 2 of 16 patients, and 5 of 5 patients vs. 3 of 18 patients respectively; p = 0.002). The development of exocrine insufficiency correlated strongly with the extent of pancreatic necrosis (r = –0.754, p < 0.001), and the severity of pancreatic endocrine insufficiency (n = 4, r = –0.453, p = 0.03). Conclusion: Pancreatic exocrine insufficiency is a common occurrence in patients recovering from severe acute pancreatitis, and its severity correlates with the extent of pancreatic necrosis and the severity of concomitant pancreatic endocrine insufficiency.

Usefulness of dynamic magnetic resonance pancreatography with secretin [correction of secretion] injection for evaluating pancreatic exocrine function after pancreatogastric reconstructive surgery.

The usefulness of dynamic magnetic resonance pancreatography (MRP) with secretin injection as a new method of assessing pancreatic exocrine function was evaluated in patients undergoing pancreatogastrostomy. A series of 12 patients who had undergone pancreatogastrostomy were classified into group 1 (9 patients whose pancreas was normal preoperatively) and group 2 (3 patients with a firm pancreas accompanied by distended pancreatic ducts). The pancreatic exocrine function was evaluated using the changes in maximum pancreatic duct diameter and the intensity ratio calculated by tracing the contour line on the images of pancreatic juice secretion newly occurring after dynamic MRP with prior secretin injection. Clear visualization of the pancreatic duct by MRP was achieved in all 12 patients, and a decrease in pancreatic duct diameter was evident postoperatively in group 2. Pancreatic juice secretion was well visualized on MRP images following secretin injection in 10 patients but not in 2 patients of group 2. Higher intensity ratios were noted in group 1 than in group 2. Dynamic MRP with secretion injection enables clear verification of pancreatic juice secretion on images and permits objective evaluation of pancreatic exocrine function. It therefore is a useful procedure for assessing pancreatic exocrine function after resection of the pancreas.

MR Imaging of the Pancreas: A Pictorial Tour

Magnetic resonance (MR) imaging of the pancreas has undergone a major change because of its capability of providing noninvasive images of the pancreatic ducts, cross-sectional images of the parenchyma analogous to computed tomography (CT) images, and angiographic depiction of blood vessels. Recent technical issues include the use of half-Fourier T2-weighted pulse sequences and the administration of secretin for MR cholangiopancreatography (MRCP). Secretin improves pancreatic duct and side-branch delineation and the detection of anatomic variants such as pancreas divisum. It allows monitoring of pancreatic flow dynamics and evaluation of pancreatic exocrine function. Although contrast material--enhanced CT is still considered the standard of reference in severe acute pancreatitis and for the detection of calcifications in chronic pancreatitis, in patients referred for suspicion of pancreatic disease or with recurrent acute pancreatitis, MR imaging and secretin-enhanced MRCP are useful after unenhanced CT suggests the cause of disease. In advanced inflammatory disease, MR imaging and secretin-enhanced MRCP are useful for planning surgery or therapeutic endoscopy and for follow-up studies after therapy. MR imaging in combination with secretin-enhanced MRCP and MR angiography is useful in identifying pancreatic malignancies and in establishing resectability.

The usefulness of secretin-enhanced MR cholangiopancreatography (S-MRCP) for evaluation of pancreatic exocrine function

The usefulness of secretin-enhanced MR cholangiopancreatography (S-MRCP) for evaluation of pancreatic exocrine function

The usefulness of secretin-enhanced MR cholangiopancreatography (S-MRCP) for evaluation of pancreatic exocrine function

The usefulness of secretin-enhanced MR cholangiopancreatography (S-MRCP) for evaluation of pancreatic exocrine function

11C]methionine positron emission tomography for the evaluation of pancreatic exocrine function in chronic pancreatitis.

Positron emission tomography (PET) can be used for the quantitative analysis of amino acid metabolism. The aim of this study was to investigate whether pancreatic exocrine function can be evaluated by [11C]methionine PET in chronic pancreatitis (CP) patients. Dynamic PET scan of the pancreas and liver was performed in eight healthy subjects and seven patients with CP after intravenous (i.v.) injection of [11C]methionine. Simultaneously, duodenal juice was collected with the background of continuous i.v. administration of secretin (125 ng/kg/h). The radioactivity ratio of the pancreas to that of the liver (PLR) was calculated by regions of interest (ROI) analysis. Amylase output and bicarbonate concentration were measured in the duodenal aspirates. The PLR of CP patients was significantly lower than that of healthy subjects at all time points after methionine injection. The PLRs at 4.5 minutes (PLR4.5) after methionine injection were positively correlated with the amylase output, mean bicarbonate concentration, and volume of duodenal aspirates (R = 0.74, 0.69, 0.46). It is concluded that [11C]methionine PET would be a noninvasive method for the evaluation of exocrine pancreatic function, which may represent total amino acids uptake of viable acinar cells in the pancreas.

Functional MRCP in Pancreatic and Periampullary Disease

The magnetic resonance (MR) evaluation of the pancreatic and biliary tree has undergone an important evolution because the introduction of the technique of MR cholangiopancreatography (MRCP). To describe and illustrate the technique of secretin-enhanced MRCP (S-MRCP) and discuss its use in pancreatic and periampullary disease. Results are based on 6 years experience using MRCP with secretin infusion in hundreds of patients in a tertiary referral center. Secretin improves pancreatic duct and side-branch delineation and the detection of anatomic variants such as pancreas divisum and abnormal common bilio-pancreatic channel. It allows monitoring of pancreatic flow dynamics and evaluation of pancreatic exocrine function that has been previously unavailable. In advanced inflammatory disease, it is useful in monitoring the course of the disease, for planning therapy and for follow-up studies after therapeutic endoscopy. Combining morphology and function into one non-invasive and comprehensive diagnostic modality has expanded the clinical applications of MRCP beyond the diagnostic ERCP that it replaces.