Document Detail

Physiological evaluation of the severity of pancreatic exocrine dysfunction during endoscopy.
MedLine Citation:
PMID:  17575542     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Despite the advances in pancreatic imaging, there continues to be a need to measure exocrine function to determine which patient requires enzyme supplementation. To evaluate the potential use of a rapid endoscopic test that can be conducted by nonacademic centers, we investigated whether concentration of trypsin in food-stimulated secretion is related to trypsin synthesis and secretion. METHODS: Subjects include 22 chronic pancreatitis patients (10 mild, 5 moderate, and 7 severe radiological disease) and 11 healthy controls. During upper gastrointestinal endoscopy, pancreatic secretion was stimulated by a single 30-mL duodenal injection of an enteral diet, followed 5 minutes later by periampullary juice aspiration (endoscopic pancreatic function test [ePFT]). This was followed by a conventional 2-hour marker-perfusion diet-stimulated pancreatic trypsin secretion and synthesis study (2-hour PFT [2hPFT]). RESULTS: Severity of radiological disease was associated with a progressive loss of enzyme secretion measured by the 2hPFT. The endoscopic PFT correlated positively with 2hPFT (r2 = 0.48; P < 0.0001) and an activity of less than 5% of the average normal had a 96% specificity and 75% sensitivity for the detection of pancreatic insufficiency as defined by a loss of greater than 90% of pancreatic secretion. CONCLUSIONS: The diagnostic power of endoscopy may be enhanced by the collection of a pancreatic juice sample after enteral feed stimulation because measurement of the trypsin content will identify chronic pancreatitis patients who will be benefited by enzyme supplementation.
Stephen J D O'Keefe; Stacie Stevens; Ronzo Lee; Wen Zhou; Alvin Zfass
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Pancreas     Volume:  35     ISSN:  1536-4828     ISO Abbreviation:  Pancreas     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-18     Completed Date:  2007-07-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  United States    
Other Details:
Languages:  eng     Pagination:  30-6     Citation Subset:  IM    
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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MeSH Terms
Amylases / metabolism,  secretion
Breath Tests
Carbon Radioisotopes / diagnostic use
Dietary Fats / pharmacokinetics
Endoscopy, Digestive System / methods*
Lipase / metabolism,  secretion
Middle Aged
Pancreas, Exocrine / enzymology,  pathology*,  physiopathology*
Pancreatic Juice / enzymology,  secretion
Pancreatitis, Chronic / pathology*,  physiopathology*,  radionuclide imaging
Sensitivity and Specificity
Severity of Illness Index*
Triolein / pharmacokinetics
Trypsin / metabolism,  secretion
Reg. No./Substance:
0/Carbon Radioisotopes; 0/Dietary Fats; 122-32-7/Triolein; EC; EC 3.2.1.-/Amylases; EC

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