Diagnostic Accuracy of a Short Endoscopic Secretin Test in Patients With Cystic Fibrosis

Abstract

ObjectiveShort endoscopic secretin tests for exocrine pancreatic function are not properly evaluated in cystic fibrosis (CF).MethodsPatients with CF and healthy controls (HCs) underwent endoscopic collection of duodenal juice between 30 and 45 minutes after secretin stimulation. Duodenal juice was analyzed for HCO3− concentration and pancreatic enzyme activities. Stool was analyzed for fecal elastase.ResultsThirty-one patients with CF and 25 HCs were tested. Patients were classified as exocrine pancreatic sufficient (n = 13) or insufficient (n = 18). Both bicarbonate concentrations and enzyme activities in duodenal juice differentiated patients with CFI from patients with CFS and HC (P < 0.001). The population displays strong correlation between severe CF genotype in both alleles and pancreatic insufficient phenotype (P < 0.001).ConclusionsPancreatic exocrine insufficient CF patients could be differentiated from exocrine sufficient patients and HCs using short endoscopic secretin test.

Pancreatic insufficiency in Cystic Fibrosis

“…Given similar results of secretin stimulated pancreatic function testing in crossover trials using Dreiling tubes and sample collection by endoscopy in healthy subjects [32] and patients with chronic pancreatitis [33], endoscopy has largely replaced the use of Dreiling tubes. A modified version of the endoscopic secretin pancreatic function test, where pancreatic fluid was collected at 30 and 45 min instead of 60 min, was able to accurately differentiate between PI-CF (n = 13) and PS-CF (n = 18) patients as well as normal controls (n = 25) [34]. The major drawbacks to the direct endoscopic function tests are that they are expensive, require an invasive procedure with sedation, lack standard protocols with clear reference values, and the brief pancreatic fluid aspiration periods can result in abnormal bicarbonate concentrations in normal individuals.…”

Assessing the impact of cystic fibrosis on the antipyretic response of ibuprofen in children: Physiologically‐based modeling as a candle in the dark

“…Model adequacy was concluded if the prediction fold error for simulated mean BE metrics, AUC 0-t and C max , were below 1.25-fold of mean observed values, ie predicted/observed ratios ranging from 0.8 to 1.25. 20 Nevertheless, in the two clinical trials that guided diseasebased pharmacokinetics model development 13 and external verification, 14 ibuprofen was administered only 10 minutes after pancreatic enzyme supplements were given to patients with a light-fat breakfast, which modulates intraluminal environment. A mean gastric residence time of 0.6 hours was estimated using the built-in parameter estimation module in the Simcyp ® simulator.…”

“…An attractive and efficient alternative would be to assess these permutations by integrating advanced in vitro product characterization and quantitative modelling.In this research, we proposed a workflow based on a stepwise modelling approach to leverage available biopharmaceutic and clinical knowledge of ibuprofen in order to assess the adequacy of the approved paediatric antipyretic dosing regimen to a commonly underrepresented population: paediatric patients with CF. The impact of CF on the gastrointestinal tract and UGT-mediated metabolism has been mapped out by different groups [4][5][6][7][8][18][19][20][21][22][23][24]. By changing the composition of intestinal fluids (eg, decreased buffer capacity of intestinal fluids) and increasing UGT-mediated clearance, CF has the potential to impair the systemic exposure of orally administered, poorly soluble weak acids that are also substrates of UGT, like ibuprofen 13,14.…”

Quantification of Pancreatic Function Using a Clinically Feasible Short Endoscopic Secretin Test

“…Stimulation with only secretin combined with an upper endoscopy is coming up the last years (191). Most articles focus on easy feasibility, performed as a short endoscopic secretin test (192)(193)(194) (197).…”