Serum immunoreactive trypsin concentration after a Lundh meal. Its value in the diagnosis of pancreatic disease.

Lake‐Bakaar, Gerond; McKavanagh, S; Redshaw, M. R.; Wood, T; Summerfield, J.A.; Elias, E. George

doi:10.1136/jcp.32.10.1003

Cited by 23 publications

(6 citation statements)

References 9 publications

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“…Our normal range for healthy controls (117-637 ,tg/l) is appreciably wider than ranges found in previous studies using the same radioimmunoassay,2 4 12 but only one study2 investigated a comparable number of subjects. There are several possible reasons for this discrepancy.…”

Section: Discussioncontrasting

confidence: 57%

Clinical value of serum immunoreactive trypsin concentration.

Ruddell¹,

Mitchell²,

Hamilton³

et al. 1981

BMJ

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The clinical value of estimation of serum concentrations of immunoreactive trypsin was evaluated by studying 46 healthy controls, 23 controls in hospital, 44 patients with chronic pancreatic disease, and 184 patients with nonpancreatic conditions in which pancreatic disease commonly enters into the differential diagnosis. Serum trypsin concentration had a log normal distribution in the controls, and the calculated normal range was considerably wider than that previously reported. The concentration was abnormal in only 13 out of 27 patients with chronic pancreatitis and was extremely variable in patients with pancreatic cancer. Abnormal results occurred in 11% of the patients with non-pancreatic disease. Eighteen patients had a subnormal trypsin concentration, of whom six did not have pancreatic disease and 12 had either chronic pancreatitis or pancreatic cancer. There was no correlation between serum trypsin concentration and mean tryptic activity as measured by the Lundh test. Of 11 patients with pancreatic steatorrhoea, only seven had subnormal trypsin concentrations.These results suggest that the serum concentrations of immunoreactive trypsin has a low specificity and sensitivity for pancreatic disease and does not reflect the degree of exocrine insufficiency in patients with proved chronic pancreatitis.

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Section: Discussioncontrasting

confidence: 57%

Clinical value of serum immunoreactive trypsin concentration.

Ruddell¹,

Mitchell²,

Hamilton³

et al. 1981

BMJ

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“…However, the finding of subnormal serum concentrations of TLI and pancreatic isoamylase provides evidence for impaired pancreatic exocrine function (12, 13). In healthy subjects, food has no influence on serum levels of TLI and pancreatic isoamylase (15,20) and, in accordance with this, we found no change in these concentrations in the diabetics after breakfast and insulin. The lacking relationship between serum concentrations of TL1 and pancreatic isoamylase and known duration of diabetes and daily insulin dose in our investigation is in agreement with several studies of duodenal pancreatic outputs of enzymes in diabetes and the above mentioned variables (3, 5, 10, 22).…”

Section: Discussionsupporting

confidence: 84%

Serum Concentration of Cathodic Trypsin‐Like Immunoreactivity and Pancreatic Isoamylase in Insulin‐Dependent Diabetes Mellitus

Møller-Petersen

KjærgÅrd

Mourits‐Andersen

et al. 1982

Journal of Internal Medicine

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ABSTRACT. The relationship between diabetes mellitus and the exocrine pancreatic function was evaluated in 29 patients with insulin‐dependent diabetes mellitus by measuring cathodic trypsin‐like immunoreactivity (TLI) and the enzymatic activity of pancreatic isoamylase in serum before and 90 min after breakfast and insulin. Thirty healthy subjects served as reference group. Median fasting serum concentrations in the diabetic subjects were significantly lower than in the reference subjects: for TLI 143 and 299 μg trypsin standard/I and for pancreatic isoamylase 43 and 101 U/I, respectively (p<0.001 for both). A positive correlation between TLI and pancreatic isoamylase was present in the diabetics (Sperman's rho=0.56, p<0.01). The serum concentrations of TLI and pancreatic isoamylase were not related to the duration of diabetes, daily insulin dose or glycemic control measured by blood glucose and total glycosylated hemoglobins. Cathodic TLI and pancreatic isoamylase in serum were not influenced by food and insulin.

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“…Serum trypsin may be normal or subnormal in chronic pancreatitis (Elias et al ., 1977). [7] Previous studies have revealed that exocrine insufficiency is invariably associated with a low trypsin concentration,[1516] but a normal concentration has been reported. [17] However, increased levels observed in the present study in CP compared to controls suggests that proteolytic activity of trypsin on pancreas may result in the cascade of events which further results in the activation of other proteases with subsequent cell damage.…”

Section: Discussionmentioning

confidence: 99%

Role of proteases and antiprotease in the etiology of chronic pancreatitis

Kavutharapu

Balakrishna

Abbagani

et al. 2012

Saudi J Gastroenterol

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Background/Aim:Chronic pancreatitis (CP) is the progressive and irreversible destruction of the pancreas characterized by the permanent loss of endocrine and exocrine function. Trypsin, the most important digestive enzyme plays a central role in the regulation of all other digestive enzymes. Chymotrypsin, an endopeptidase hydrolyzes peptides at amino acids with aromatic side chains. Alpha-1-antitrypsin is a principal antiprotease which protects the mucosal tissue from the proteolytic effects of trypsin and chymotrypsin by the formation of molar complexes. The present study is aimed at examining the role of proteases (trypsin and chymotrypsin) and anti-protease (α1-anti-trypsin) in the etiopathogenesis of chronic pancreatitis.Patients and Methods:A total of 90 CP patients and 110 age and sex matched controls were considered for the study. Serum trypsin, chymotrypsin and α1-anti-trypsin levels were determined prospectively in CP patients and compared to healthy controls as described previously.Results:The mean activity of trypsin were found to be increased in CP patients (X ± SD = 0.82 ± 0.838) in comparison to normal control group (X ± SD = 0.55 ± 0.328), (P = 0.001). Chymotrypsin activity were also found to be elevated in CP patients (X ± SD = 0.63 ± 0.278) in comparison to control group (X ± SD = 0.39 ± 0.295), (P = 0.0001). The mean α-1-anti-trypsin activity were found to be lowered in CP patients (X ± SD = 0.42 ± 0.494) in comparison to control group (X ± SD = 0.67 ± 0.465), with the variation being significant (P = 0.0003).Conclusion:The findings suggest an imbalance in the synthesis and degradation of proteolytic enzymes and antiprotease indicating an altered aggressive and defensive role in the pathogenesis of chronic pancreatitis.

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Serum immunoreactive trypsin concentration after a Lundh meal. Its value in the diagnosis of pancreatic disease.

Cited by 23 publications

References 9 publications

Clinical value of serum immunoreactive trypsin concentration.

Clinical value of serum immunoreactive trypsin concentration.

Serum Concentration of Cathodic Trypsin‐Like Immunoreactivity and Pancreatic Isoamylase in Insulin‐Dependent Diabetes Mellitus

Role of proteases and antiprotease in the etiology of chronic pancreatitis

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