#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Laboratory diagnostics of exocrine function of the pancreas


Authors: P. Kocna
Authors‘ workplace: Ústav lékařské biochemie a laboratorní diagnostiky VFN a 1. LF UK - Laboratoř gastroenterologie
Published in: Klin. Biochem. Metab., 28, 2020, No. 4, p. 150-160

Overview

The clinical significance of the determination of exocrine pancreatic function lies primarily in the diagnosis of exocrine pancreatic insufficiency (PEI) and its relationship to chronic pancreatitis (CHP). This review represents a wide range of exocrine pancreatic functions, direct (intubation or endoscopic), indirect - oral tests, stool analysis (fat or pancreatic enzymes), breath tests and plasma nutrient markers that can be used to diagnose PEI and CHP. The choice of an appropriate test must be adapted to the clinical scenario. This overview evaluates and describes the individual functional tests and trends in their use in routine clinical practice. The article also includes current international recommendations and the gastroenterological laboratory’s own experience.

Keywords:

exocrine pancreas – Functional tests – chronic pancreatitis – exocrine pancreatic insufficiency – Clinical guidelines


Sources

1.    Keller, J., Aghdassi, A. A., Lerch, M. M. et al. Tests of pancreatic exocrine function - clinical significance in pancreatic and non-pancreatic disorders. Best Pract. Res. Clin. Gastroenterol., 2009, 23/3, p. 425-439.

2.    Löhr, J. M., Dominguez-Munoz, E., Rosendahl, J. et al. HaPanEU/UEG Working. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis. United Eur. Gastroenterol. J. 2017, 5/2, p. 153-199.

3.    Carnie, L. E., Lamarca, A., McNamara, M. G. et al. The assessment of pancreatic exocrine function in patients with inoperable pancreatic cancer: In need of a new gold-standard. Pancreatology, 2020, 20/4, p. 668-675

4.    Sperti, C., Moletta, L. Staging chronic pancreatitis with exocrine function tests: Are we better? World J Gastroenterol., 2017, 23/38, p. 6927-6930

5.    Lieb, J. G., Draganov, P. V. Pancreatic function testing: here to stay for the 21st century. World J Gastroenterol., 2008, 14/20, p. 3149-3158.

6.    Boeck, W. G., Adler, G., Gress, T. M.  Pancreatic Function Tests: When to Choose, What to Use. Curr. Gastroenterol. Rep., 3001, 3, p. 95-100

7.    Dreiling, D. A., Hollander, F. Studies in pancreatic function; preliminary series of clinical studies with the secretin test. Gastroenterology, 1948, 11, p. 714-729

8.    Lundh, G. Pancreatic exocrine function in neoplastic and inflammatory disease, a simple and reliable new test. Gastroenterology, 1962, 42, p. 275-280.

9.    Madzak, A., Engjom, T., Wathle, G. K., et al. Secretin-stimulated MRI assessment of exocrine pancreatic  function in patients with cystic fibrosis and healthy controls. Abdom. Radiol. (NY). 2017, 42/3, p. 890-899.

10. Engjom, T., Tjora, E., Erchinger, F., et al. Secretin-Stimulated Magnetic Resonance Imaging Reveals Variable Diagnostic Accuracy According to Etiology in Pancreatic Disease. Pancreas, 2020, 49/3, p. 361-367.

11.   Engjom, T., Tjora, E., Wathle, G., et al. Secretin-sti-mulated ultrasound estimation of pancreatic secretion in cystic fibrosis validated by magnetic resonance imaging.  Eur. Radiol., 2018, 28/4, p. 1495-1503

12. Lara, L. F., Takita, M., Burdick, J. S., et al. A study of the clinical utility of a 20-minute secretin-stimulated endoscopic pancreas function test and performance according to clinical variables. Gastrointest. Endosc., 2017, 86/6, p. 1048-1055.

13. Van Slyke, D. D., Neill, J. M., The determination of gases in blood and other solutions by vacuum extraction and manometric measurement. J. Biol. Chem., 1924, 61, p. 523-573.

14. Erchinger, F., Engjom, T., Gudbrandsen, O. A., et al. Automated spectrophotometric bicarbonate analysis in duodenal juice compared to the back titration method. Pancreatology, 2016, 16/2, p. 231-237.

15. Engjom, T., Erchinger, F., Tjora, E., et al. Diagnostic accuracy of secretin-stimulated ultrasonography of the pancreas assessing exocrine pancreatic failure in cystic fibrosis and chronic pancreatitis. Scand. J Gastroenterol., 2015, 50/5, p. 601-610.

16. Imondi, A. R., Stradley, R. P., Wolgemuth, R. Synthetic peptides in the diagnosis of exocrine pancreatic insufficiency in animals. Gut., 1972, 13/9, p. 726-731.

17. Malis, F., Fric, P., Kasafírek, E., Slaby, J. Comparative study of the estimation of exocrine pancreatic function using p-(N-acetyl-L-tyrosyl)- and p-(N-benzoyl-L-tyrosyl) aminobenzoic acid. Hepatogastroenterology, 1983, 30/3, p. 99-101.

18. Bures, J., Fixa, B., Hottmarová, A. et al. Study of the Exocrine Secretory Function of the Pancreas Using the SPOFA-GNOST Kit. First Personal Experience. Vnitr. Lek., 1984, 30/3, p. 279-283.

19. Lankisch, P. G., Brauneis, J., Otto, J., Göke, B. Pancreolauryl and NBT-PABA tests. Are serum tests more practicable alternatives to urine tests in the diagnosis of exocrine pancreatic insufficiency? Gastroenterology, 1986, 90/2, p. 350-354.

20. Hoek, F. J., Vandenbergh, F. A. G., Klein Elhorst, J. T. et al. Improved specifity of the PABA test with p-aminosalicylic acid (PAS). Gut, 1987, 28, p. 468-473.

21. Chen, W. L., Morishita, R., Eguchi, T. et al. Clinical Usefulness of Dual-Label Schilling Test for Pancreatic Exocrine Function. Gastroenterology, 1989, 96/5/1, p. 1337-1345.

22. Ishii, Y., Kohno, T., Ito, A. et al. Measurement of extra-pancreatic secretory function by 13C-dipeptide breath test. Transl. Res., 2007, 149/6, p. 298-303.

23. Kocna, P., Frič, P., Slabý, J., Novinky v biochemické diagnostice chorob pankreatu. in Nové diagnostické metody a jejich přínos pro lékař.praxi. ed. Hyánek, J. Vrbová, H. Universita Karlova Praha, 1990, p. 118-122

24.   Perušičová, J., Kocna, P., Vztah mezi poruchou vnitřní a zevní funkce pankreatu u nemocných s chronickou pankreatitidou., Čs. Gastroent. výživa, 1989, 43/2, p. 73-79

25. Nakamura, H., Morifuji, M., Murakami, Y., et al. Usefulness of a 13C-labeled mixed triglyceride breath test for assessing pancreatic exocrine function after pan-creatic surgery. Surgery, 2009, 145/2, p. 168-175.

26. Domínguez-Muñoz, J. E., Iglesias-García, J., Iglesias-Rey, M. et al. Effect of the administration sche-dule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study. Aliment. Pharmacol. Ther., 2005, 21/8, p. 993-1000.

27. Chleboun, J., Kocna P., Isotope selective nondispersive infrared spectrometry can compete with isotope ratio mass spectrometry in cumulative 13CO2 breath tests: Assessment of accuracy. Klin. Biochem. Metabol., 2005, 13, p. 92-97.

28. Kocna, P., Vaníčková, Z., Krechler, T. et al. Testy exokrinní funkce pankreatu - elastáza 1 ve stolici a dechový test s 13C-MTG. HPB Bulletin 2006, 14/3, p. 97-99

29. Drummey, G. D., Benson, J. A., Jones, C. M. Microscopical examination of the stool for steatorrhea. N Engl. J Med., 1961, 264, p. 85-87.

30. Khouri, M. R., Huang, G., Shiau, Y. F., Sudan Stain of Fecal Fat: New Insight Into an Old Test. Gastroentero-logy, 1989, 96/2, p. 421-427.

31. Tran, M., Forget, P., Van den Neucker, A. et al. The acid steatocrit: a much improved method. J Pediatr. Gastroenterol. Nutr., 1994, 19/3, p. 299-303.

32. Amann, S. T., Josephson, S. A., Toskes, P. P. Acid steatocrit: a simple, rapid gravimetric method to determine steatorrhea. Am. J Gastroenterol., 1997, 92, p. 2280-2284.

33. Kamath, M. G., Pai, C. G., Kamath, A., Kurien, A. Comparing acid steatocrit and faecal elastase estimations for use in M-ANNHEIM staging for pancreatitis. World J Gastroenterol., 2017, 23/12, p. 2217-2222.

34. Lieb, J. G., Draganov, P. V. Pancreatic function testing: here to stay for the 21st century. World J Gastroenterol., 2008, 14/20, p. 3149-3158.

35. Erchinger, F., Engjom, T., Jurmy, P. et al. Fecal Fat Analyses in Chronic Pancreatitis Importance of Fat Ingestion before Stool Collection. PLoS One, 2017, 12/1, e0169993.

36. Van De Kamer, J. H.: Quantitative Determination of the Saturated and Unsaturated Higher Fatty Acids in Fecal Fat. Scand. J Clin. Lab. Invest., 1953, 5/1, p. 30-36.

37. Neucker, A. V., Bijleveld, C. M., Wolthers, B. G., et al. Comparison of near infrared reflectance analysis of fecal fat, nitrogen and water with conventional methods, and fecal energy content. Clin. Biochem., 2002, 35/1, p. 29-33.

38. Fine, K. D., Fordtran, J. S. The effect of diarrhea on fecal fat excretion. Gastroenterology, 1992, 102/6, p. 1936-1939.

39. Capurso, G., Traini, M., Piciucchi, M. et al. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin. Exp. Gastroenterol., 2019, 12, p. 129-139.

40. Schlaeger, R., Röhr, A. Faecal chymotrypsin--a new photometric method using N-acetyl-L-tyrosine ethyl ester as substrate. J Clin. Chem. Clin. Biochem., 1982, 20/3, p. 147-150.

41. Kaspar, P., Möller, G., Wahlefeld, A. New photometric assay for chymotrypsin in stool. Clin. Chem., 1984, 30/11, p. 1753-1757.

42. Lankisch, P. G. Exocrine pancreatic function tests. Gut. 1982, 23/9, p. 777-798.

43. Stockbrügger, R. W., Armbrecht, U., Müller, E., Heusinger, A. Determination of faecal chymotrypsin concentration and 72-hour faecal chymotrypsin output in the detection of pancreatic steatorrhoea. Scand. J Gastroenterol. Suppl., 1991, 188, p. 13-19.

44. Lüth, S., Teyssen, S., Forssmann, K. et al. Fecal elastase-1 determination: ‘gold standard’ of indirect pancreatic function tests? Scand. J Gastroenterol., 2001, 36/10, p. 1092-1099.

45. Stevens, T., Conwell, D., Zuccaro, G., et al. Analysis of pancreatic elastase-1 concentrations in duodenal aspirates from healthy subjects and patients with chronic pancreatitis. Dig. Dis. Sci., 2004, 49/9, p. 1405-1411.

46. Tóth, A. Z., Szabó, A., Hegyi, E. et al. Detection of human elastase isoforms by the ScheBo Pancreatic Elastase 1 Test. Am. J Physiol. Gastrointest. Liver Physiol., 2017, 312/6, G606-G614.

47. Weiss, F. U., Budde, C., Lerch, M. M. Specificity of a Polyclonal Fecal Elastase ELISA for CELA3. PLoS One, 2016, 11/7, e0159363.

48. Schneider, A., Funk, B., Caspary, W., Stein, J., Monoclonal versus polyclonal ELISA for assessment of fecal elastase concentration: pitfalls of a new assay. Clin. Chem., 2005, 51/6, p. 1052-1054.

49. Vanga, R. R, Tansel, A., Sidiq, S. et al. Diagnostic Performance of Measurement of Fecal Elastase-1 in Detection of Exocrine Pancreatic Insufficiency: Systematic Review and Meta-analysis. Clin. Gastroenterol. Hepatol., 2018, 16/8, p. 1220-1228.

50. Forsmark, C. E. Diagnosis and Management of Exocrine Pancreatic Insufficiency. Curr. Treat. Options Gastroenterol., 2018, 16/3, p. 306-315.

51. Stern, I., Roberts-Thomson, I. C., Hansky, J. Correlation between pancreatic polypeptide response to secretin and ERCP findings in chronic pancreatitis. Gut, 1982, 23/3, p. 235-238.

52. Gullo, L., Pezzilli, R., Ventrucci, M. Diagnostic value of the amino acid consumption test in pancreatic di-seases. Pancreas, 1996, 12/1, p. 64-67

53. Lindkvist, B., Domínguez-Muñoz, J. E., Luaces-Regueira, M. et al. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatology, 2012, 12/4, p. 305-310.

54. Büchler, M. W., Malfertheiner, P., A proposal for new classification of chronic pancreatitis based on clinical picture, imaging and pancreatic function. Chronic pancreatitis - International Meeting EDS/EAGE Postgraduate Course, Bern, 2000.

55. Kocna, P., Laboratorní diagnostika malabsorpčního syndromu. in Gastroenterologie 2006 - Collectio novissima, ed. Bureš J., Triton-Praha, 2006, p. 181-198

56. Kocna, P., Kohout, P., Clinical, therapeutical and economical benefit of exocrine pancreatic function tests. Pancreatology, 2012, 12/6, p. 521

Labels
Clinical biochemistry Nuclear medicine Nutritive therapist
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#