Diagnosis of Chronic Pancreatic Disease

Beck, Ivan T.

doi:10.1007/978-1-4615-3314-6_12

Cited by 1 publication

(8 citation statements)

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“…Other screening tests for pancreatic maldigestion: The 14 C triolein and fatty acid absorption and breath tests (the first depends on duodenal lipase activity and the second on intestinal absorption) have been used to differentiate between maldigestion and malabsorption. However, similar to the nonradioactive 13 C-CO 2 breath test for fat and carbohydrate digestion, the 14 C fat absorption tests become positive only in patients with severe pancreatic insufficiency (1,2).…”

Section: Screening Tests For Pancreatic Maldigestionmentioning

confidence: 98%

“…Because 90% of lipase activity has to be destroyed before even the accurate 72 h fecal fat balance study becomes abnormal, it is not astonishing that the sensitivity of the pancreolauryl test (which is based on a single dose of administered fluorescein fat) is low (8). The sensitivity of the test was reported in severe pancreatic disease to be between 80 and 90% but it is much lower in mild chronic pancreatitis (1). Bentiromide test: This test is based on the digestion of benzoyl-L tyrosil-L-p-aminobenzoic acid (NBT-PABA).…”

Section: Screening Tests For Pancreatic Maldigestionmentioning

confidence: 99%

“…For instance, the above-mentioned hormones increase secretion of calcium and lactoferrin, and abnormally high concentrations can be measured in duodenal juice of patients with early chronic pancreatitis. However, duodenal lactoferrin levels are also elevated in patients with duodenitis (1,2). A pancreatic function test was developed incorporating 75 Se methionine into pancreatic proteins.…”

Section: Tests Requiring Duodenal Intubationmentioning

confidence: 99%

“…The clinical symptoms, biochemical abnormalities and anatomical distortions in both conditions are due to ductal obstruction, diminished parenchymal or ductal-cell function and the presence of mass lesions. Except in the case of functioning islet cell tumours (which are not the subject of this review), differentiation between the two conditions may be very difficult (1)(2)(3). As shown in Figures 3 and 4, cystic and solid tumours can occur in chronic pancreatitis as well as in benign and malignant neoplasms (4).…”

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confidence: 99%

“…Other conditions that lead to pancreatic insufficiency without pancreatitis or cancer (such as cystic fibrosis, primary pancreatic atrophy of childhood, adult pancreatic lipomatosis or isolated lipase-colipase deficiency, etc) will not be discussed although these conditions may also lead to abnormal pancreatic function tests. The subject of the present paper was reviewed in more detail by the author two years ago (1). The present paper is a more general overview and a critical assessment of the methods used and an update on recent developments.…”

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confidence: 99%

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Critical Review of Diagnostic Methods Used in Chronic Pancreatic Disease

Beck

1995

Canadian Journal of Gastroenterology and Hepatology

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This paper provides a balanced assessment of the various pancreatic function tests and imaging techniques used in the differential diagnosis of chronic pancreatic disease. Function tests that study the digestive capacity of the pancreas (fat absorption of dietary lipids, fluorescein- or radiolabelled fats, bentiromide test, etc) have high specificity, but very low sensitivity. This is because 90% of pancreas has to be destroyed before steatorrhea or creatorrhea occurs. Tests that directly measure pancreatic bicarbonate and protein secretion (secretin test, etc) are more accurate and may detect pancreatic dysfunction even before anatomical changes occur. Measurement of pancreatic enzymes in serum or urine, or the decreased decline of serum amino acids during their incorporation into pancreatic enzymes, are not sufficiently sensitive or specific to help diagnose pancreatic disease. Sensitive and specific tumour markers are not yet available. Thus screening tests are not cost-effective - if they are negative, they do not exclude pancreatic disease; and if positive, they have to be confirmed by more specific tests. Imaging techniques are the most commonly used methods of investigation. The usefulness of abdominal survey films, barium studies, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography, computed tomographic scan, magnetic resonance imaging and endoscopic ultrasonography is critically reviewed. Most of the radiological methods can be combined with cytology or biopsy. Histology demonstrating malignancy establishes this diagnosis, but negative biopsies do not exclude malignant tumours. Presently only ERCP and endoscopic ultrasound can diagnose cancers sufficiently early to allow for possible `curative' surgery, and only endoscopic ultrasound is capable to stage tumours for the assessment of resectability.

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Section: Screening Tests For Pancreatic Maldigestionmentioning

confidence: 98%

Section: Screening Tests For Pancreatic Maldigestionmentioning

confidence: 99%

Section: Tests Requiring Duodenal Intubationmentioning

confidence: 99%

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confidence: 99%

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