Diagnostic Value of the Fecal Chymotrypsin Test in Pancreatic Insufficiency, Particularly Chronic Pancreatitis: Correlation with the Pancreozymin-Secretin Test, Fecal Fat Excretion and Final Clinical Diagnosis

Abstract

The diagnostic value of the fecal chymotrypsin test (FCT) was reevaluated with regard to (a) proved pancreatic hypofunction of different severity (183 pancreozymin-secretin tests); (b) the final clinical diagnosis, and (c) fecal fat excretion (208 patients with chronic pancreatitis; CP). Progressive pancreatic disease (cancer, CP) was mainly associated with moderate or severe pancreatic hypofunction (119/138; 86.2%) and a low incidence of false-normal FCT values (14/138; 10.1%). Miscellaneous disorders (mainly reversible pancreatic hypofunction) were mainly associated with slight pancreatic hypofunction and a high incidence of false-normal FCT values (17/45; 37.8%). Pancreatic steatorrhea ( > 10g/day) was found only in patients with markedly depressed FCT values. Progressive deterioration of pancreatic function was demonstrated by repeated FCT in CP (n = 220).

Fecal Fat Concentration in the Screening of Steatorrhea

“…A possible alternative could only be represented by fecal chymotrypsin. which is measured in spot samples and is correlated with steatorrhea [8].…”

“…Its quantitation is an essential parameter mainly in the follow-up of the affected pa tients in order to know when nutritional defi cits develop and also to monitor need and efficacy of therapeutic interventions [1], In fact, steatorrhea is a late finding in the natural history of the diseases possibly causing malab sorption [2,3], and therefore its measurement is not sensitive enough to be considered a diagnostic tool [4], The fat malabsorption is usually quantitated by the fat balance. This requires the collection of all stools produced during a long enough period, a diet of known fat content, the stool homogenization and the use of a complex and unpleasant titrimctric assay [5], The indirect tests of fat malabsorp tion so far suggested (l4C-triolcin measure ment in stools [6] and in the expired air [7], tubeless pancreatic function tests [8,9]) are too complex, time-consuming, and not accu rate enough [10. 11].…”

CFTR Gene Mutation in Patients with Apparently Idiopathic Pancreatitis: Lack of Phenotype-Genotype Correlation

“…Excess alcohol intake (pure alcohol consumption ≥30 g/day for more than 2 years), biliary lithiasis (presence of gallbladder, common bile duct lithiasis or sludge) [17,18], hypercalcemia (>3 mmol/l) [19], hypertriglyceridemia (>10 mmol/l) [20], drugs/medication causing acute pancreatitis, personal history of abdominal radiotherapy [21], autoimmune disease (personal history of autoimmune disease, dosing of gammaglobulin, immunoglobulin A, G (including subfraction IgG4) and M, Latex Waaler-Rose, anti-nuclear antibodies, anti-smooth muscle antibodies, anti-mitochondrial antibodies, anti-neutrophil cytoplasmic antibodies) [22], traumatic pancreatitis and duct obstruction (mainly due to tumor) were ruled out in all patients. Besides the search for CF mutations, a hereditary cause of pancreatitis was systematically ruled out by questioning patients about family history and by searching for cationic trypsinogen gene mutations [14,16,23,24,25]. Patients with SPINK1 mutations (n = 2), which are considered as ‘disease modifiers’ rather than a causative agent, were not excluded from the study.…”

“…Recurrent pancreatitis was defined as at least two episodes of acute pancreatitis: acute pain in the upper abdomen associated with serum lipase at least 3 times the upper limit of normal and/or CT signs of pancreatitis [27,28,29]. The diagnosis of exocrine pancreatic insufficiency was based on clinical steatorrhea [23]. Biliary stenosis was defined as the common bile duct narrowing into the pancreatic head associated with biochemical cholestasis that lasted for more than 1 month.…”

Assessment of Exocrine Pancreatic Dysfunction in Chronic Pancreatitis

“…The duodenal intubation test is an invasive but reliable test of exocrine pancreatic function. Although the secretin (S) test is now considered the ‘gold-standard’ test as a duodenal intubation method in Japan [5, 9], it is not popular compared to noninvasive tests such as the BT-PABA (N-benzoyl- L -tyrosyl- p -aminobenzoic acid) test [10, 11, 12]or fetal chymotrypsin test (FCT) [13, 14, 15]. In this study, our aims were to determine the clinical means of the assessment of exocrine pancreatic dysfunction in CP using the secretin test, BT-PABA test and FCT.…”