Pancreatic Function Tests: Comparison of Standard and Augmented Secretin

The results of standard and augmented secretin tests have been compared in the diagnosis of pancreatic exocrine disease. Eighty-six patients had a standard secretin test utilising 1 unit per kg body weight secretin. Mean peak bicarbonate concentration was 104 mEq/ litre in 43 normal subjects compared with 64 mEq/litre in 30 patients with chronic pancreatitis. Of these 30 patients, seven had normal peak bicarbonate concentration giving a diagnostic error of 23%. Assessment of other parameters of pancreatic secretion, namely total bicarbonate output and fluid output, did not improve this figure. Ninety-six patients had an augmented secretin test of 2–3 units per kg body weight. Mean peak bicarbonate concentration in normals was 97 mEq/litre compared with 51 mEq/ litre in 36 patients with chronic pancreatitis. Of the latter group, four had peak bicarbonate concentration in the normal range (11% diagnostic error) but only two had total bicarbonate output in the normal range (5–6%diagnostic error). However, in six patients who were subsequently shown to have a normal pancreas, four had abnormal peak bicarbonate concentration and five an abnormal bicarbonate output. These results indicate that augmented secretin correctly diagnoses chronic pancreatitis more frequently than a standard test but at the expense of incorrectly indicating chronic pancreatitis when this is not present.     

An evaluation of 75Se Selenomethionine scanning as a test of pancreatic function compared with the secretin-pancreozymin test

The uptake of ⁷⁵Se Selenomethionine by the pancreas has been evaluated in 102 patients and compared with the secretin-pancreozymin test of pancreatic function. In groups of patients with chronic pancreatitis and cancer of the pancreas abnormal scans closely parallel the diminished exocrine secretion, especially bicarbonate output, following a submaximal dose of secretin. Thirty per cent of the group with no pancreatic abnormality have abnormal scans, though the secretinpancreozymin test is normal. Though a normal scan excludes the presence of chronic pancreatitis and cancer of the pancreas with a probability greater than 90%, an abnormal scan is found so frequently in normal subjects that it does not provide a reliable index of impaired pancreatic function.     

Comparison of the Secretin Stimulated Endoscopic Pancreatic Function Test to Retrograde Pancreatogram

Duodenal intubation techniques with hormonal stimulation are the most accurate at diagnosing early chronic pancreatitis. Pancreatography (ERCP), the radiologic gold standard, can accurately diagnose chronic pancreatitis, but is expensive, may expose the patient to radiation, and/or induce acute pancreatitis. We have developed an endoscopic pancreatic function test (ePFT) that can assess pancreatic secretory function during upper endoscopy. We sought to determine the accuracy of the endoscopic secretin pancreatic function test using retrograde pancreatogram as the gold standard. Patients referred to The Pancreas Clinic for the evaluation and management of chronic abdominal pain and suspected chronic pancreatitis who had both endoscopic function testing and pancreatic duct imaging (ERCP) were studied. Pancreatograms were scored for duct morphologic characteristics (Cambridge classification) and compared to peak bicarbonate concentration in secretin stimulated duodenal juice. The ePFT consisted of a test dose of intravenous synthetic porcine secretin (0.2 microg), full-dose intravenous secretin (0.2 microg/kg) over 1 min, (3) upper endoscopy with moderate sedation, (4) gastric fluid aspirated and discarded, (5) duodenal fluid aspirations at 0, 15, 45, and 60 min after secretin injection, and (6) fluid analysis with lab autoanalyzer for bicarbonate concentration (historical normal cutpoint >80 mEq/L). Thirty-six patients had both the endoscopic function test and ERCP. Seventeen had chronic abdominal pain with normal pancreatograms, and nineteen had chronic abdominal pain with abnormal pancreatograms, consistent with chronic pancreatitis. The sensitivity and specificity of the endoscopic function test were 94% and 79%, respectively. The positive and negative predictive values were 80% and 94%, respectively. Overall agreement with ERCP was 86%. The ePFT with synthetic porcine secretin has excellent correlation with abnormal pancreatogram (chronic pancreatitis). Furthermore, a normal bicarbonate (negative function test, HCO(3) >80 mEq/L) essentially rules out chronic pancreatitis as a diagnostic cause of abdominal pain. Endoscopic pancreatic function testing may decrease the need for ERCP in patients with chronic abdominal pain.     

Pancreatic polypeptide release stimulated by food, secretin and cholecystokinin in chronic pancreatitis

The pancreatic polypeptide (PP) release after a standard meal and the PP release and the pancreatic secretion of bicarbonate and amylase after stimulation by secretin GIH, 1 CU kg-1 intravenously, and by cholecystokinin (CCK), 1 Ivy dog unit kg-1 intravenously, have been investigated in 10 patients with chronic pancreatitis. Significant correlations were found between the integrated PP responses after food and hormonal stimulation (p less than 0.05), between the integrated PP response and the peak serum PP concentration after food (p less than 0.01) and after secretin/CCK (p less than 0.01), and between the peak serum PP concentrations obtained after food, secretin, and CCK (p less than 0.01). The pancreatic outputs of bicarbonate and amylase and the peak amylase concentration after hormonal stimulation were significantly correlated (p less than 0.01), but no significant correlation was found between any one of these variables of exocrine pancreatic function and the PP release. It is concluded that, in chronic pancreatitis, food, secretin, and CCK stimulate PP release similarly and that no correlation can be established between the PP release and the exocrine pancreatic secretion.     

An endoscopic pancreatic function test with synthetic porcine secretin for the evaluation of chronic abdominal pain and suspected chronic pancreatitis

BACKGROUND: Pancreatic function tests are the most reliable methods for the diagnosis or exclusion of chronic pancreatitis in patients without obvious radiologic changes, but they are cumbersome, time consuming, and unavailable in clinical practice. Synthetic porcine secretin, a 27 amino acid peptide identical to the biologic form, is available for exocrine function testing. This study examined the utility of a simple, newly developed, purely endoscopic pancreatic function test with synthetic porcine secretin. METHODS: Three groups of patients were studied: patients with chronic abdominal pain with and without risk factors for chronic pancreatitis, and patients with advanced chronic pancreatitis. All patients with abdominal pain had "pancreatic type" pain for greater than 6 months and negative radiographic imaging studies. All patients with chronic pancreatitis had advanced disease based on retrograde pancreatography and/or CT findings. Participants underwent the following protocol: (1) standard endoscopy to the descending duodenum with the patient under conscious sedation; (2) intravenous administration of secretin (0.2 microgram/kg); (3) endoscopic duodenal fluid collection at 0, 15, 30, 45, and 60 minutes after secretin injection; and (4) fluid analysis for bicarbonate concentration. RESULTS: Eighteen patients were studied (5 abdominal pain without risk factors, 7 abdominal pain with risk factors, and 6 advanced chronic pancreatitis). Median peak (interquartile range) bicarbonate concentrations in meq/L for each group were, respectively, 87 (6, range 84-108), 72 (10, range 68-90), and 35 (27, range 18-88). Median peak bicarbonate concentration values for the 3 groups are significantly different (p = 0.010; Kruskal-Wallis test). Bicarbonate secretion in patients with chronic pancreatitis was markedly reduced compared with that in patients with abdominal pain without risk factors (p = 0.038; the Fisher exact test). The secretory function curve for patients with abdominal pain with risk factors was markedly abnormal, resembling the attenuated secretory curve seen in patients with chronic pancreatitis. The test was safe and well tolerated. CONCLUSIONS: A simple endoscopic pancreatic function test with synthetic porcine secretin appears to distinguish patients with known chronic pancreatitis from those with chronic abdominal pain without chronic pancreatitis. This simple, practical endoscopic test can be performed during upper endoscopy and may decrease the need for invasive procedures in patients with abdominal pain and normal radiographic imaging studies.     

Relation between morphologic changes in the main pancreatic duct and exocrine pancreatic function after a secretin test

INTRODUCTION: Because pancreatic exocrine function testing methods are problematic, both imaging and functional tests are important in the diagnosis of chronic pancreatitis. AIM: To evaluate the usefulness of ultrasonographic monitoring of the main pancreatic duct after a secretin test. METHODOLOGY: A total of 70 subjects (30 control subjects, 26 patients with probable chronic pancreatitis, and 14 patients with definite chronic pancreatitis) were selected. The main pancreatic duct diameters were measured serially after an injection of secretin (100 IU/body). The relation between the magnitude of the duct dilation and exocrine pancreatic function on the secretin test was evaluated. RESULTS: The main pancreatic duct dilated immediately after a bolus injection of secretin, showed a peak after 2-5 minutes, and recovered gradually. The response curve of the definite group had a flatter pattern than that of the other groups. For the maximal to basal duct diameter ratio, statistically significant differences were found between the control and definite groups and between the control and probable groups. In addition, the ratio correlated significantly with the maximal bicarbonate concentration and secretory volume on the secretin test. CONCLUSIONS: The results of the current study indicate that exocrine pancreatic function and the morphologic changes of the main pancreatic duct are significantly related. Dynamic ultrasonographic findings may reflect pancreatic function; consequently, this test may be a useful tool in the diagnosis of chronic pancreatitis.     

Evaluation of pancreatic exocrine function by secretin-enhanced magnetic resonance cholangiopancreatography

AIM: To assess the feasibility and usefulness of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) for evaluation of pancreatic exocrine function. METHODOLOGY: S-MRCP was performed in 20 patients with mild (n = 8) or severe (n = 12) chronic pancreatitis (according to the grade of exocrine pancreatic insufficiency indicated by the Lundh test) and in 10 volunteers without pancreatic disease. MRCP images were evaluated before and 10 minutes after the intravenous administration of 0.5 IU/kg secretin. The changes in pancreatic tissue T2 signal intensity and duodenal filling after the injection of secretin were determined by means of S-MRCP. The S-MRCP findings were then compared with those of the Lundh test. RESULTS: The pancreatic T2 signal intensity showed a significant elevation after secretin administration in the volunteers and in the patients with mild or severe chronic pancreatitis. This elevation was significantly lower in patients with mild and severe chronic pancreatitis than in the volunteers (66.85+/-15.77 and 24.45+/-5.85 vs. 200.0+/-45.07, respectively). After administration of secretin. the diameter of the duodenum was significantly increased in all three groups. This duodenal filling was significantly reduced in patients with mild or severe exocrine pancreatic insufficiency as compared with the volunteers (4.12+/-1.33 and 1.70+/-0.77 vs. 15.38+/-1.73, respectively). There was no significant difference in pancreatic T2 signal intensity changes or in duodenal filling in patients with mild or severe exocrine pancreatic insufficiency. There were significant correlations between the pancreatic T2 signal intensity changes and the duodenal filling and the results of the Lundh test (r = -0.616 and -0.78). CONCLUSION: These results demonstrate that the administration of secretin increases the T2 signal intensity of the pancreatic tissue and the diameter of the duodenum to different extents in normal subjects and in patients with chronic pancreatitis. This suggests that S-MRCP can provide information of value in the assessment of an exocrine pancreatic insufficiency.     

Oral Administration of Chymotrypsin Labile Peptide for a New Test of Exocrine Pancreatic Function (PFT) in Comparison with Pancreozymin-secretin Test

A new test using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (N-BT-PABA) for an evaluation of exocrine pancreatic function was compared with a pancreozymin-secretin test in 38 subjects. Urinary recovery of PABA, which is absorbed from the intestine and conjugated in the liver after an oral administration of N-BT-PABA, depends mainly on chymotrypsin activity. The recovery rate of PABA in urine decreases in chronic pancreatitis, in which chymotrypsin activity in the duodenal juice is disturbed. The recovery rate of PABA in calcifying chronic pancreatitis was 40.2 +/- 15% and significantly less than 81.2 +/- 7.4% in normal subjects (P less than 0.01). The amount of PABA in urine during eight hours was correlated with parameters of volume output- bicarbonate concentration and amylase output stimulated by injections of pancreozymin and secretin (P-S test). The new test using N-BT-PABA is useful for the evaluation of exocrine pancreatic function in general practice.     

Pancreatic enzyme synthesis in pancreatic disease

In a prospective evaluation of patients suspected of having chronic pancreatitis, synthesis of pancreatic enzymes was measured by means of the incorporation of selenium-75-labelled methionine into the proteins of duodenal aspirate during stimulation of pancreatic secretion with secretin (1 CU X kg-1 X h-1) plus cholecystokinin (CCK) (1 IDU X kg-1 X h-1). The rate of pancreatic enzyme synthesis was increased in patients with chronic pancreatitis. Measurement of pancreatic enzyme synthesis was more sensitive in the detection of chronic pancreatitis than either the bicarbonate or the trypsin secretory response to secretin plus CCK. A combination of the bicarbonate secretory response with measurement of the rate of enzyme synthesis provided a positive predictive power of 100% when both tests were abnormal and a negative predictive power of 100% when both tests were normal, so that the combined test can be recommended both for excluding and confirming the presence of chronic pancreatitis.     

Evaluation of exocrine pancreatic function by the haptocorrin degradation test of the duodenal fluid collected by endoscopy

Two groups of biological methods are commonly used to evaluate the exocrine pancreatic function: tests which require tubes for the collection of duodenal juice and the tubeless tests which are indirect tests of pancreatic function. In this study we have attempted to improve a new test: the test of haptocorrin degradation (THD). This test measures the transfer of labelled cobalamin from haptocorrin to the intrinsic factor which is provoked by the degradation of the haptocorrin by proteases in the duodenal juice. We present the results of this test in 90 patients with chronic pancreatitis. THD was first assayed with basal duodenal juice collected by naso duodenal tubing during secretin cerulein stimulation. In this study the sensitivity and specificity of THD was 0.86 and 0.93, respectively. In the second part of this study we demonstrated that the means of collecting duodenal juice had no effect on the results of THD. Duodenal juice was collected during a secretin cerulein test or during a routine upper gastrointestinal endoscopy after pancreatic stimulation with secretin. The sensitivity and specificity of THD was 0.90 and 0.94, respectively, when duodenal juice was collected during endoscopy. THD was significantly correlated with the NBT-PABA test, steatorrhea, and with the activity of trypsin and chymotrypsin in the duodenal juice. In this study, NBT-PABA was less sensitive than THD for the diagnosis of chronic pancreatitis (sensitivity was 0.70 and 0.89, respectively). The specificity of THD was estimated at 0.94. THD seemed to be a valuable adjunct to test pancreatic function. As upper gastrointestinal endoscopy is usually performed in patients with proved or suspected chronic pancreatitis, THD seems to have a place of choice among the other tests of pancreatic exocrine function. Further evaluation of this test by a multicentric prospective trial is now needed.     

Relationship between Pancreatic Exocrine Function and Histological Changes in Chronic Pancreatitis

To confirm correlation between function and histology of the exocrine pancreas in chronic pancreatitis, we compared exocrine pancreatic function, as estimated by cholecystokinin secretin test (CST), with histological findings in 108 patients. Exocrine pancreatic insufficiency was graded from 0 to 4 according to the number of abnormal CST parameters. Histological findings also were graded from 0 to 4. Results of CST in 108 patients were normal (grade 0) in 52, equivocal (grade 1) in 23, and abnormal (grades 2-4) in 33. Normal histological findings (grade 0) were observed in 54 patients, equivocal (grade 1) in 15, and abnormal (grades 2-4) in 39. We confirmed that there was a significant correlation between histological grading and overall scoring (tau = 0.59, p less than 0.01) or individual parameters (tau = -0.36 for volume, -0.45 for amylase output, and -0.54 for maximal bicarbonate concentration (p less than 0.01) of CST. Sensitivity of CST was 67% in 39 patients with histologically confirmed chronic pancreatitis, specificity was 90% in 69 patients without chronic pancreatitis, based on histological evidence, and efficiency was 81%. In conclusion, we confirmed a highly significant correlation between direct function test (CST) and histology of the exocrine pancreas.     

Parotid salivary gland function in patients with exocrine pancreatic insufficiency

Parotid function tests were performed on 12 patients with pancreatic insufficiency due to chronic pancreatitis. The concentrations of sodium and bicarbonate in stimulated parotid juice were reduced compared to controls (p less than 0.001). The secretion of 75Se-selenomethionine by the parotid salivary gland and exocrine pancreas following a Lundh test meal was measured in 12 patients with normal pancreatic function and 16 patients with exocrine pancreatic insufficiency. Eight of these patients had chronic pancreatitis both parotid and pancreatic secretion of the isotope were impaired. In pancreatic carcinoma the pancreatic excretion was impaired with no significant impairment of parotid secretion. The combined pancreatic/parotid radio-selenium test may be useful in differentiating between chronic pancreatitis and pancreatic carcinoma as the cause of pancreatic insufficiency.     

A Rapid,Endoscopic Exocrine Pancreatic Function Test and the Lundh Test: A Comparative Study

Background/Aims: The diagnosis of chronic pancreatitis is often difficult in the early stages of the disease. Morphological tests may be normal, and reliable methods for the evaluation of the exocrine pancreatic function are time-consuming and troublesome. A new test for exocrine pancreatic function, using endoscopic aspiration of secretin-stimulated pancreatic juice, has been developed. We evaluated the test using the Lundh meal test as reference. Methods: The endoscopie secretin stimulation test (ESST) was performed in a consecutive row of 24 patients referred for pancreatic function testing because of clinical suspicion of chronic pancreatitis and in 23 healthy volunteers. The participants fasted overnight and secretin was given intravenously (1 CU/kg) as a bolus the following morning. Thirty minutes after administration of secretin, the tip of the duodenoscope was placed close to the ampulla of Vater and duodenal aspirate was drawn for 10 min. Intraduodenal concentrations of lipase, bicarbonate, elastase and zinc were measured. The concentration of lipase during the Lundh test (4 × 20 min aspiration) was used as reference test in the patients. Results: Judged from the Lundh test, the exocrine pancreatic function was nearly abolished in 5 patients (<10% of lower normal limit), reduced in 6 patients and normal in 13 patients. ESST failed in 1 patient (no aspirate). Lipase concentrations (KU/I) were significantly lower in the patients with nearly abolished function compared to patients with reduced or normal exocrine pancreatic function (NEPF; Mann-Whitney U test: p < 0.01), but an overlap was found between patients with reduced exocrine pancreatic function [100.1 (median); 60.0–225.0 (range)] patients with NEPF (145.7; 44.6–268.0) and healthy controls (175.0; 84.8–381.0). Bicarbonate concentrations (mEq/l) were significantly lower in patients with reduced exocrine pancreatic fuction (51.2; 32.5–69.6) compared to patients with NEPF (80.0; 48.1–101.8; Mann-Whitney U test: p < 0.05). Pancreatic elastase concentration was significantly lower in the group with nearly abolished exocrine function compared to patients with NEPF (Mann-Whitney U test: p < 0.05), but there was no difference between elastase concentrations among the other groups. We found significant correlation between lipase and bicarbonate concentrations during ESST and lipase concentrations during the Lundh test in all 23 patients (Spearman's Ranktest: p = 0.597 and 0.683, respectively, p < 0.01). By using receiver operating characteristic curves, best cut-off point for bicarbonate was estimated. Lipase and bicarbonate results in the healthy volunteers were not statistically different from results in patients with NEPF. No side effects were observed except for worsening of nausea and abdominal pain in 2 of the patients. Conclusion: The ESST is safe, and by combining the estimation of lipase and bicarbonate concentrations this test is a rapid, easy and useful diagnostic test for exocrine pancreatic function.     

Assessment of exocrine pancreatic dysfunction in chronic pancreatitis

The clinical diagnosis of chronic pancreatitis is usually based on imaging studies, pancreatic function tests, and the presence of characteristic clinical features. In Japan, diagnostic criteria for chronic pancreatitis were established in 1995. The secretin test (a duodenal intubation test) and the combination of noninvasive tests, N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) and fecal chymotrypsin (FCT), have been recommended for evaluating exocrine pancreatic function in patients with chronic pancreatitis. In the present study, the diagnostic value of these two noninvasive tests was compared to the secretin test. Although noninvasive tests are less sensitive and specific for determining exocrine pancreatic dysfunction than the secretin test, greater reliability for diagnosing chronic pancreatitis can be obtained by performing the BT-PABA and FCT simultaneously. Assessment of exocrine pancreatic function is important not only to diagnose chronic pancreatitis but also to decide a treatment method with pancreatic enzyme preparation.     

Somatostatin analog, SMS 201-995, inhibits pancreatic exocrine secretion and release of secretin and cholecystokinin in rats.

We studied the effect of a synthetic octapeptide somatostatin analog, SMS 201-995 (sandostatin), on pancreatic exocrine secretion and on plasma secretin and cholecystokinin (CCK) levels in vivo in anesthetized rats. The exocrine pancreas was stimulated by either intravenous infusion of both secretin (0.06 CU/kg/h) and cholecystokinin octapeptide (CCK-8) (0.03 micrograms/kg/h) or intraduodenal infusion of oleic acid (pH 6.5) in a dose of 0.25 mmol/h. Intravenous administration of SMS 201-995 in three different doses of 100, 200, and 400 ng/kg/h resulted in dose-related inhibition of pancreatic secretion in terms of volume, bicarbonate, and amylase stimulated by exogenous secretin and CCK. Intraduodenal oleic acid stimulated pancreatic secretion, including volume, bicarbonate, and amylase, and this was accompanied by a significant elevation in the plasma concentrations of secretin and CCK. Intravenous administration of SMS 201-995 in the three different doses described above caused dose-dependent suppression of the increase in pancreatic exocrine secretion as well as the plasma concentration of secretin and CCK induced by intraduodenal infusion of oleic acid. It is concluded that SMS 201-995 inhibits pancreatic exocrine secretion and the release of endogenous hormones, such as secretin and CCK, in rats.     

Pancreatic exocrine function

Summary The relative value of certain tests of pancreatic exocrine function was assessed by the sequential administration of (1) an augmented dose of secretin, (2) an augmented dose of pancreozymin, and (3) a test meal. Eighty-one individuals were studied—namely, the control group of 47 persons (24 healthy volunteers and 23 patients with nonpancreatic disease) and a group of 34 patients with pancreatic disease. The latter group included 17 patients with chronic pancreatitis: 2 with subacute relapsing pancreatitis and 15 with carcinoma of the pancreas. Measurements of volume, bicarbonate output (peak and total), and bicarbonate concentration (maximal and 60-min.) were made with and without reference to body weight, after administration of secretin. Concentrations and outputs of trypsin and amylase were measured after the administration of pancreozymin and the test meal.The augmented secretin test yielded the most reliable results, both in indicating pancreatic disease and in differentiating between chronic pancreatitis and pancreatic carcinoma; measurements of volume output per kilogram of body weight, peak or total bicarbonate output, and maximal bicarbonate concentration were the most appropriate data for these purposes. Satisfactory, but less reliable, results were those of secretion that followed the administration of an augmented dose of pancreozymin or a test meal; the findings after these two tests were comparable. Mayo Clinic Rochester, Minn. 55902This investigation was supported in part by Research Grant AM-06908 from the National Institutes of Health, U. S. Public Health Service.We are grateful to our colleagues for referring patients for this study, and to Sister Victor, Director of Dietetics, St. Marys Hospital, Rochester, Minnesota, for preparation of the special test meal.Research assistant in gastroenterology and recipient of a Wellcome Travel Grant.Research assistant in biochemistry.     

Use of caerulein with submaximal doses of secretin as a test of pancreatic function in man.

The pancreatic exocrine secretory response to different combinations of the pancreozymin-like peptide caerulein and secretin was studied in 110 healthy control subjects and 32 patients with pancreatic disease. A combination of 0-5 CU/kg-h secretin and 75 ng/kg-h caerulein provided maximal or near-maximal stimulation of the secretion of both bicarbonate and pancreatic enzymes. The combination of stimulant peptides in the above doses was found to give excellent separation between the secretion of bicarbonate, lipase, and chymotrypsin of the control group and patients with chronic pancreatitis. A combination of caerulein and secretin represents a safe, reliable, and effective mean of stimulating pancreatic exocrine secretion for the purpose of testing pancreatic function.     

Comparative study of secretin and Lundh tests

Exocrine pancreatic function in 19 patients with pancreatic disease and in 14 of 16 controls was measured by secretin stimulation and by the Lundh test on two different occasions. Peak bicarbonate concentration in the secretin test and mean trypsin concentration in the Lundh test emerged as the most reliable parameters. No additional diagnostic value was obtained by measuring enzymes after secretin injection. In 6 patients with chronic and in 8 of 13 patients with acute pancreatitis, both tests gave results that agreed with each other. The remaining 5 patients showed either an abnormal secretin value or an abnormal Lundh test. This is consistent with the wide variation seen in acute pancreatitis. It is concluded that the Lundh test as well as the secretin test were of value in the assessment of chronic pancreatic disease. The secretin test may be slightly more sensitive to mild and acute pancreatic damage than is the Lundh test. However stimulation of the pancreas by a test meal is easier to perform and more economic.Partly presented at the Annual Meeting of the American College of Gastroenterology in Hawaii, October, 1973.     

The diagnostic value of the amino acid absorption test in detection of a disorder of exocrine pancreatic function]

The amino acid consumption test (AACT) during exogenous stimulation with secretin and CCK was proposed as a sensitive and highly specific test for detection of exocrine pancreatic insufficiency. To further investigate the diagnostic value of this test we measured the AACT in comparison with the pancreolauryl serum test (PLT) in patients with chronic pancreatitis and in patients with gastrointestinal diseases but without pancreatic disease. A total of 48 patients, 23 patients with chronic pancreatitis (CP) and 25 patients with gastrointestinal diseases, were included in the study. Diagnosis of chronic pancreatitis was established by standardized morphological criteria in ultrasound, ERCP, CT, and was confirmed by surgery in 11 cases. The PLT was abnormal in 83% of patients with chronic pancreatitis and normal in 92% of the control subjects (diagnostic accuracy 88%). Basal amino acid concentration was comparable in patients with chronic pancreatitis and in control subjects (300 +/- 12 [symbol: see text] 325 +/- 16 mumol/l). The peak decrease of amino acids occurred after 30 min during combined stimulation with secretin and ceruletide and was not different between the two groups (CP: 11.2 +/- 1.7%, controls: 13.9 +/- 1.9% below basal values). With a 12% decrease of amino acids as cutoff, sensitivity was 74% and specificity 52% (diagnostic accuracy 63%). Integrated amino acid decrease did not show any significant differences between CP and controls (CP: 228 +/- 63% min, controls: 397 +/- 80% min). Determination of the individual amino acids serine, valine, histidine, and isoleucine could also not discriminate between patients with chronic pancreatitis and other gastrointestinal diseases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical studies on human pancreatic deoxyribonuclease I.

Duodenal juice collected after administration of Boot's pancreozymin and secretin to patients with various pancreatic diseases was subjected to deoxyribonuclease I (DNase I) assay, as well as measurements of total volume, amylase output and maximum bicarbonate concentration. It was observed that the DNase I output is well correlated with each of three factors. The DNase I output was much lower in patients with chronic pancreatitis or pancreatic cancer than in control subjects, and DNase I output was even found to be low in patients suspected of having chronic pancreatitis, who did not give abnormal resulsts with other assay methods. These results imply that DNase I output may be a good indicator of exocrine function of the pancreas, and thus may be useful for early detection of pancreatic diseases.