Dual marker one day pancreolauryl test.

Abstract

There is a pressing need for a simple noninvasive test of exocrine pancreatic function for use in children. The pancreolauryl test has been modified by the addition of a second marker (mannitol) to achieve a single day test without the need for two timed urine collections. Six healthy subjects and nine patients with cystic fibrosis were studied. Fluorescein, fluorescein dilaurate, and mannitol were taken by mouth, alone or in combinations, followed by 10 hour urine collections in two hourly aliquots to study the comparative pharmacokinetics of these markers. by the development of a dual marker system which involves the inclusion of a second marker with absorption, distribution, and excretion characteristics similar to that of free fluorescein, to eliminate the second day of the test and to shorten the duration of the collection of urine. Mannitol, which has been used extensively for the measurement of intestinal permeability in infancy and childhood,'"' has been chosen as such a marker.The aims of this study were to compare fluorescein and mannitol as markers and to establish the suitability of the latter for combination with fluorescein dilaurate in a simplified one day test ofexocrine pancreatic function. We have used the new test to measure exocrine pancreatic function in healthy controls and in those with depressed function due to cystic fibrosis. Subjects and methods SUBJECTSSix healthy adults (four men, two women, aged 29-40 years) were studied, and nine subjects with cystic fibrosis (six male, three female, aged 6-25 years). All the patients with cystic fibrosis had had the diagnosis confirmed by sweat test and were judged clinically to require pancreatic enzyme supplementation.

ESPGHAN and NASPGHAN Report on the Assessment of Exocrine Pancreatic Function and Pancreatitis in Children

“…The free fluorescein is systemically absorbed from the intestinal lumen and can be measured in the urine (49) (and also from blood (50)). The original test was modified by adding a second marker mannitol, to correct for changes in intestinal permeability (51). The results are reported as a fluorescein/mannitol ratio.…”

Assessment of exocrine pancreatic function in children and adolescents with direct and indirect testing

“…Pancreatic lipase releases the fluorescein that is then absorbed and can be measured in the urine ( 96 ) and blood ( 97 ). Later the test was modified by adding mannitol to correct for changes in intestinal permeability that could affect absorption and skew the test results ( 98 ). The results are reported as a fluorescein/mannitol ratio.…”