Test Of Exocrine Pancreatic Function Research Articles

Dynamics of perioperative pancreatic exocrine function in patients undergoing reconstruction after gastrectomy for gastric cancer.

Each method of reconstruction after gastrectomy results in a change in the digestive and absorptive status. However, there are few reports on the changes in pancreatic exocrine function after gastrectomy. We conducted this study to investigate the dynamics of pancreatic exocrine function after gastrectomy according to the method of reconstruction performed. The subjects of this study were 45 patients who underwent pancreatic exocrine function tests preoperatively and postoperatively, from among all patients who underwent gastrectomy for gastric cancer at our hospital between September, 2020 and March, 2022. We assessed pancreatic exocrine function using the Pancreatic Function Diagnostant (PFD) test. The mean preoperative PFD test result values for the distal gastrectomy (DG) Billroth I reconstruction (B-I) group and the DG Roux-en-Y reconstruction (R-Y) group were 62.6 and 67.3 (p = 0.36), respectively, and the mean postoperative PFD test result values for each group were 65.8 and 46.9 (p = 0.0094), respectively. A significant decrease in postoperative pancreatic function was observed in the DG R-Y group but not in the DG B-I group. The logistic regression analysis identified that age and the R-Y group were significantly correlated with a 10% decrease in the PFD value after gastrectomy. Our study suggests that R-Y reconstruction may result in more impaired pancreatic exocrine function than B-I reconstruction.

DEPEND study protocol: early detection of patients with pancreatic cancer – a pilot study to evaluate the utility of faecal elastase-1 and 13C-mixed triglyceride breath test as screening tools in high-risk individuals

IntroductionPancreatic cancer (PC) is the fifth leading cause of cancer-related death in the UK. The incidence of PC is increasing, with little or no improvement in overall survival and the...

Pancreatic exocrine insufficiency and pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer: A systematic review and meta-analysis.

Pancreatic cancer is the fourth leading cause of cancer mortality. Most patients are diagnosed with advanced pancreatic cancer, either at locally advanced or metastatic stages, and have a high rate of malnutrition and weight loss which are associated with poor outcomes. Pancreatic exocrine insufficiency is one of the causes of malnutrition and weight loss in these patients. The prevalence and clinical consequences of pancreatic exocrine insufficiency in advanced pancreatic cancer are poorly investigated with heterogeneous results. We sought to determine the prevalence and clinical consequences of pancreatic exocrine insufficiency and the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer by systematic review and meta-analysis. Scopus, Medline, and Embase were searched for cohort studies or randomised clinical trials reporting pancreatic exocrine insufficiency and/or the effect of pancreatic enzyme replacement therapy in patients with advanced pancreatic cancer. We considered pancreatic exocrine insufficiency as an abnormal result on direct and/or indirect pancreatic exocrine function tests. Pancreatic enzyme replacement therapy was evaluated by its effect on survival and quality of life in patients with advanced pancreatic cancer. A total of 11 studies were included; seven studies reported the prevalence of pancreatic exocrine insufficiency and seven the effect of pancreatic enzyme replacement therapy in advanced pancreatic cancer. The pooled prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer was 72% (95% confidence interval: 55-86%), being significantly higher when tumours were located in the pancreatic head (relative risk = 3.36, 1.07-10.54; p = 0.04) six studies investigated the impact of pancreatic enzyme replacement therapy on survival/quality of life. Pancreatic enzyme replacement therapy was associated with 3.8 months (95% confidence interval: 1.37-6.19) survival benefit. Patients receiving pancreatic enzyme replacement therapy had a trend towards a better quality of life.Conclusions The prevalence of pancreatic exocrine insufficiency in advanced pancreatic cancer is substantial and its treatment can improve the outcomes of these patients.

Report on the Short Endoscopic Exocrine Pancreatic Function Test in Children and Young Adults.

Endoscopic pancreatic function test (ePFT) has been in use for exocrine function testing since the 1990s. In patients, short ePFT assesses acinar function, unlike the longer version for ductal function in adults. The present study summarizes characteristics of 1913 short ePFTs (S-ePFT) performed at 2 centers since 2001. The main indications in patients presenting at ages infancy to 24.3 years, for the S-ePFT were failure to thrive, weight loss, diarrhea, and abdominal pain with bloating. Secretin was administered as bolus, and 4 aliquots of fluid were collected between 4 and 10 minutes after administration. Amylase, lipase, trypsin, and chymotrypsin activities were measured in the laboratory. The pH of consecutive samples increased by 0.3 to 0.7. Overall, 36.7% had abnormal S-ePFT with selective amylase deficiency (9.5%) and generalized enzyme deficiency (8.9%) being the most frequent. Retest reproducibility, repeatability, and clinical validity were high. By adding S-ePFT to endoscopy for the suspicion of malabsorption, the abnormal findings increased by 36.9%. Short ePFT assesses pancreatic acinar function in a reliable and clinically meaningful way in patients. Diagnostic yield of endoscopy increased substantially albeit with increased sedation time. By S-ePFT ductal function, cytokines and proteomics can also be assessed.

Pancreatic Malnutrition in Children.

Exocrine pancreatic insufficiency in children can lead to lifelong complications related to malnutrition and poor growth. The clinical presentation can be subtle in the early stages of insufficiency as the large functional capacity of the pancreas is gradually lost. The pediatrician plays a crucial role in the early identification of these children to ensure a timely referral so that a diagnosis can be made and therapy initiated. Early nutritional therapy allows for prevention and correction of deficiencies, which leads to improved outcomes and survival. When insufficiency is suspected, the workup should start with an indirect test of exocrine pancreatic function, such as fecal elastase, to establish the diagnosis. Once a diagnosis is established, further testing to delineate the etiology should be pursued, with cystic fibrosis being high on the differential list and assessed for with a sweat test. Assessment of anthropometry at every visit is key, as is monitoring of laboratory parameters and physical examination findings that are suggestive of malabsorption and malnutrition. The mainstay of management is administration of exogenous pancreatic enzymes to facilitate digestion and absorption. [Pediatr Ann. 2019;48(11):e441-e447.].

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.

Cholesteryl octanoate breath test. Preliminary studies on a new noninvasive test of human pancreatic exocrine function.

A new breath test for noninvasive assessment of pancreatic exocrine function in humans was developed. The test is based on the hydrolysis of cholesteryl-[1-14C]octanoate by pancreatic carboxyl ester lipase (cholesterol esterase) with subsequent absorption and hepatic metabolism of the liberated octanoate to 14CO2. The rate at which 14CO2 appears in breath appeared to be proportional to the rate of hydrolysis. The substrate is administered as a gum acacia stabilized emulsion of vegetable oil (18 g) containing cholesteryl octanoate (2 g; 4.4 microCi) dispersed in a 500-ml isotonic meal. Tests were performed in 6 healthy volunteers and 11 patients with pancreatic disease with varying degrees of steatorrhea. In healthy subjects, 14CO2 output was rapid with peak output occurring at 60-90 min in all subjects; cumulative output in 4 h averaged 30%. Duplicate studies indicated that the time-course of 14CO2 recovery was reproducible. The pattern of 14CO2 output in patients with pancreatic disease varied widely. Patients without steatorrhea (fecal fat less than or equal to 7 g/day) or with mild steatorrhea (fecal fat 7-11 g/day) had normal or near normal patterns of 14CO2 output, whereas patients with moderate or severe steatorrhea (fecal fat greater than 11 g/day) expired 14CO2 at a rate one-third to one-tenth that of the healthy volunteers. Addition of pancreatic enzyme supplementation to the test meal increased 14CO2 output in 6 of 6 patients with moderate or severe steatorrhea, suggesting that the activity of pancreatic carboxyl ester lipase was rate limiting in these patients. In an additional study in a healthy volunteer, 14CO2 and 13CO2 were measured simultaneously in breath after ingestion of a test meal containing cholesteryl-[1-13C]octanoate and 14C-octanoate. 14CO2 was expired more rapidly than 13CO2, suggesting that hydrolysis of the substrate may also be rate limiting in healthy volunteers. These studies indicate that severe pancreatic exocrine dysfunction can be detected with a simple breath test in 60-90 min.

Exocrine Pancreatic Insufficiency: A Literature Review

Exocrine pancreatic insufficiency (EPI) is a clinical entity that manifests as a mal absorption syndrome. Its relationship with multiple worldwide-highly prevalent pancreatic and extra pancreatic affections constitutes a major health problem due to high morbidity and mortality rates. The underlying disease requires an exhaustive assessment to identify possible nutritional deficiencies so as to prevent future complications. An impaired hydro electrolytic balance and low levels of serum nutritional markers indicate or predict EPI in high risk subjects. Unfortunately, pancreatic exocrine function test available so far do not diagnose early stages of the disease but they are quite effective in advanced EPI. Imaging studies are essential in the overall management of EPI as they may provide information regarding the etiology and structural pancreatic modifications. ERCP, despite post-procedure complications, is considered the gold standard due to its diagnostic and therapeutic properties. Treatment is based on pancreatic enzyme replacement therapy (PERT) along with nutritional supplements intake and good control of the underlying disease.

Automated spectrophotometric bicarbonate analysis in duodenal juice compared to the back titration method.

We have recently evaluated a short endoscopic secretin test for exocrine pancreatic function. Bicarbonate concentration in duodenal juice is an important parameter in this test. Measurement of bicarbonate by back titration as the gold standard method is time consuming, expensive and technically difficult, thus a simplified method is warranted. We aimed to evaluate an automated spectrophotometric method in samples spanning the effective range of bicarbonate concentrations in duodenal juice. We also evaluated if freezing of samples before analyses would affect its results. Patients routinely examined with short endoscopic secretin test suspected to have decreased pancreatic function of various reasons were included. Bicarbonate in duodenal juice was quantified by back titration and automatic spectrophotometry. Both fresh and thawed samples were analysed spectrophotometrically. 177 samples from 71 patients were analysed. Correlation coefficient of all measurements was r=0.98 (p<0.001). Correlation coefficient of fresh versus frozen samples conducted with automatic spectrophotometry (n=25): r=0.96 (p<0.001) CONCLUSIONS: The measurement of bicarbonate in fresh and thawed samples by automatic spectrophotometrical analysis correlates excellent with the back titration gold standard. This is a major simplification of direct pancreas function testing, and allows a wider distribution of bicarbonate testing in duodenal juice. Extreme values for Bicarbonate concentration achieved by the autoanalyser method have to be interpreted with caution.

Noninvasive investigation of exocrine pancreatic function: Feasibility of cine dynamic MRCP with a spatially selective inversion-recovery pulse.

To investigate the feasibility of noncontrast-enhanced cine dynamic magnetic resonance cholangiopancreatography (MRCP) with a spatially selective inversion-recovery (IR) pulse for evaluating exocrine pancreatic function in comparison with the N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) test as a pancreatic exocrine function test. Twenty subjects with or without chronic pancreatitis were included. MRCP with a spatially selective IR pulse was repeated every 15 seconds for 5 minutes to acquire a total of 20 images (cine-dynamic MRCP). The median and mean frequency of the observation (the number of times) and the moving distance (mean secretion grading scores) of pancreatic juice inflow on cine-dynamic MRCP were compared with a BT-PABA test. The urinary PABA excretion rate (%) had significant positive correlations with both the mean secretion grade (r = 0.66, P = 0.002) and frequency of secretory inflow (r = 0.62, P = 0.004) in cine dynamic MRCP. Both the mean frequency of observations of pancreatic secretory inflow (1.4 ± 1.6 times vs. 14.3 ± 4.2 times, P < 0.001) and the mean secretion grade (grade = 0.16 ± 0.24 vs. grade = 1.81 ± 0.81, P < 0.001) was significantly lower in the chronic pancreatitis group than in the normal subject group. Cine dynamic MRCP with a spatially selective IR pulse may have potential for estimating the pancreatic exocrine function noninvasively as a substitute for the BT-PABA test.

A Case of Lipomatous Pseudohypertrophy of the Pancreas Diagnosed by Typical Imaging

Lipomatous pseudohypertrophy of the pancreas is an extremely rare disease, and is characterized by the replacement of pancreatic acinar cells with adipose tissue, although the pancreatic duct and islets are preserved. We report the case of a 64-year-old female who was undergoing treatment for Hashimoto's disease at a nearby clinic. For the previous two years, she had experienced an unpleasant feeling in the upper abdominal area after eating oily foods. For the previous six months, she had also suffered from lower-back pain, and presented at our hospital. Abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas. Endoscopic retrograde cholangiopancreatography revealed no anatomical abnormality or narrowing of the main pancreatic duct; the main pancreatic duct was normal up to the pancreatic tail and the branches of the pancreatic duct did not show any abnormalities. While the serum levels of the pancreatic enzymes were considerably low, according to the data of the pancreatic exocrine function test (N-benzoyl-tyrosyl-p-aminobenzoic acid test), endocrine function was maintained. On the basis of the abovementioned findings, we diagnosed lipomatous pseudohypertrophy of the pancreas. Lipomatous pseudohypertrophy of the pancreas is a very rare disease characterized by the disappearance of pancreatic exocrine tissue due to adipose tissue replacement, although the pancreatic duct and islets remain intact. Even though it has been suggested that the diagnosis of lipomatous pseudohypertrophy of the pancreas should be based on histological findings, this case indicated the possibility that lipomatous pseudohypertrophy of the pancreas may be diagnosed solely by typical imaging findings and serological data.

Secretin

This review describes the history of secretin discovery, identification, purification, and structural determination; cloning of secretin and its receptor; synthetic secretin; and highly specific and sensitive radioimmunoassay to define the characteristic physiological role on postprandial pancreatic fluid and bicarbonate secretion, which requires robust potentiation by cholecystokinin. Secretin plays a key role in the negative and positive regulatory mechanisms of exocrine pancreatic secretion. Secretin-releasing peptides were discovered in duodenal acid perfusates of both rat and dog and in canine pancreatic juice. The release and action of secretin and secretin-releasing peptides are in part mediated via vagovagal reflex mechanism involving afferent sensory neurons in proximal intestine and efferent cholinergic neurons in the pancreas. Besides acetylcholine, many neurotransmitters or neuromodulators influence release and action of secretin. The action of secretin in the pancreas depends on insulin, which also suppresses local release of somatostatin and pancreatic polypeptide. Thus, release and action of secretin are mediated via neurohormonal interaction. Clinical conditions with hypersecretinemia and hyposecretinemia are discussed. Synthetic human secretin is used for studies of exocrine pancreatic secretion, secretin-enhanced magnetic resonance cholangiopancreatography combined with exocrine pancreatic function test and diagnosis of gastrinoma syndrome. Therapeutic use of secretin is considered for the relief of severe pain in chronic pancreatitis.

237 A new endoscopic short test for exocrine pancreatic function in cystic fibrosis

237 A new endoscopic short test for exocrine pancreatic function in cystic fibrosis

239 Parenchymal and functional ultrasonographic imaging of the pancreas in cystic fibrosis correlates with exocrine pancreatic function

237 A new endoscopic short test for exocrine pancreatic function in cystic fibrosis T. Engjom1,2, B.N. Laerum3, F. Erchinger2,4, E. Tjora5,6, O.H. Gilja1,2,7, G. Dimcevski1,2. 1Haukeland University Hospital, Section for Gastroenterology, Bergen, Norway; 2University of Bergen, Institute of Medicine, Bergen, Norway; 3Haukeland University Hospital, Department of Thoracic Medicine, Bergen, Norway; 4Voss Hospital, Department of Medicine, Voss, Norway; 5Haukeland University Hospital, Department of Paediatry, Bergen, Norway; 6University of Bergen, Institute for Clinical Medicine, Bergen, Norway; 7Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway

238 Faecal calprotectin is increased in CF patients with pancreatic insufficiency

237 A new endoscopic short test for exocrine pancreatic function in cystic fibrosis T. Engjom1,2, B.N. Laerum3, F. Erchinger2,4, E. Tjora5,6, O.H. Gilja1,2,7, G. Dimcevski1,2. 1Haukeland University Hospital, Section for Gastroenterology, Bergen, Norway; 2University of Bergen, Institute of Medicine, Bergen, Norway; 3Haukeland University Hospital, Department of Thoracic Medicine, Bergen, Norway; 4Voss Hospital, Department of Medicine, Voss, Norway; 5Haukeland University Hospital, Department of Paediatry, Bergen, Norway; 6University of Bergen, Institute for Clinical Medicine, Bergen, Norway; 7Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway

Clinical, Therapeutical And Economical Benefit Of Exocrine Pancreatic Function Tests

Clinical, Therapeutical And Economical Benefit Of Exocrine Pancreatic Function Tests

13C Breath Tests for the Assessment of Exocrine Pancreatic Function

The secretin-pancreozymin test is regarded as the most accurate of the pancreatic exocrine function tests but is cumbersome, time consuming, and invasive because it requires duodenal intubation and hormonal stimulation of the pancreas. Fecal analysis of fat, fecal elastase, or chymotrypsin are more practicable but far less sensitive to detect early stages of pancreatic exocrine insufficiency. Several (13)C-labeled substrates that are digested by pancreatic enzymes have been proposed for breath tests, thus assessing the intraluminal activity of pancreatic enzymes and therewith the pancreatic exocrine function. Particularly in pediatrics, (13)C breath tests are suited not only for diagnosis of pancreatic exocrine disorder, but also for therapy control under pancreatic enzyme substitution. However, the costs of substrates, the high time expenditure, and the lack of standardization still limit the clinical use of these breath tests. This review aims to place into perspective the traditional pancreatic exocrine function tests and the newer (13)C breath tests.

Interpretations: How to use faecal elastase testing

A number of tests of exocrine pancreatic function have been devised over the years, but the search for a simple and yet sensitive and specific test has been elusive until...

The revised Japanese clinical diagnostic criteria for chronic pancreatitis

In Japan, we are now using the clinical diagnostic criteria for chronic pancreatitis (CP) that were revised in 2001 to add the findings of magnetic resonance cholangiopancreatography to the criteria compiled by the Japan Pancreas Society (JPS) in 1995. Because the current criteria are set for diagnosing advanced CP, they are unlikely to improve patients' prognoses. In addition, they seem unsuitable for current clinical practice because exocrine pancreatic function tests, which have become obsolete in Japan, are included in the diagnostic factors. For these reasons, the Research Committee on Intractable Pancreatic Diseases supported by the Ministry of Health, Labour and Welfare of Japan, the JPS and the Japanese Society of Gastroenterology have revised the criteria. The revised criteria are unique in that they contain an introduction to the concept of early CP. It is a challenge aimed at improvement of the long-term prognosis of CP patients by early diagnosis and therapeutic intervention in this disease. We need to determine and clarify the clinico-pathological outcome of early CP by a prospective long-term follow-up of the patients in this category.

P081 - Pancreatic insufficiency in inflammatory bowel disease. Assessment by fecal elastase-1

Clinically significant disease of the pancreas in association with inflammatory bowel disease (IBD) is unusual but reported. IBD patients have a risk of developing pancreatitis as well as pancreatic insufficiency (PI). Pancreatic elastase-1 is a human and pancreas specific enzyme that is not degraded during intestinal transport and correlates with exocrine pancreatic function test. The aim of this study was to evaluate the relationship between inflammatory bowel disease and pancreatic insufficiency as an extraintestinal manifestation of IBD.