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Critical evaluation of pancreatic function tests

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Ricerca in clinica e in laboratorio

Summary

By critically evaluating the test employed in the diagnosis of chronic pancreatitis a number of considerations can be done. First of all the best discrimination between subjects with normal pancreatic function and patients with pancreatic insufficiency is given by direct hormonal stimulation tests using secretin and/or pancreozymin. Caerulein too, in a next future, could become a good tool in the functional diagnosis of the chronic pancreatitis. A more adequate statistical evaluation of the results seems also to improve the accuracy of the diagnostic classification. Without such an adequate statistical approach all the exopancreatic functional parameters (volume, HCO −3 output, enzyme output) still merit full consideration since all these ‘variables’ improve the quality of the diagnostic information. Tests based on indirect functional stimulation of the pancreas, such as the Lundh test meal and other tests using intraduodenal perfusion with basic food elements, give less valid diagnostic information in comparison with direct stimulation tests. However, for therapeutic purposes, the indirect tests are sometimes more suitable, since they give information on the true post-prandial digestive capacity of the examined patient, whether the duodenal or the pancreatic area is responsible for the functional defect. Particularly interesting is the assay of radioactivity in the duodenal aspirate after the Lundh test meal and, above all, after the administration of secretin and pancreozymin. The latter procedure, in fact, ignores endogenous production of secretin and pancreozymin and enables easy measurement of volume and, therefore, accurate determination of the % of75Se-seleniomethionine. This test may be supplemented by the simultaneous calculation of volume, HCO −3 and enzymes, as well as by sequential scintiphotography. This radioselenium test represents, therefore, an useful alternative of the classical secretin-pancreozymin test. A large number of ‘older’ diagnostic tests (serum provocative tests, tolerance tests, scintigraphy or scintiphotography alone) should instead be forgotten. These, in fact, dot not give reliable information or, even worse, they often suggest an incorrect diagnosis of chronic pancreatitis.

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Abbreviations

CCK · PZ:

Cholecystokinin-Pancreozymin

CHR U:

Crick Harper and Raper Units

CU:

Clinical Units

IU:

International Units

Ivy U:

Ivy Units

S:

Secretin

SU:

Somogyi Units

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  1. Divisione di Gastroenterologia, Ospedale Generale Regionale di Bolzano, Via Sernesi 1, 39100, Bolzano, Italia

    Giorgio Dobrilla, Giorgio Cavallini, Italo Vantini, Gianpaolo Angelini, Rita Mirachian & Ludovico A. Scuro

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  1. Giorgio Dobrilla
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  4. Gianpaolo Angelini
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  6. Ludovico A. Scuro
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The following have collaborated in the collection of personal experimental material mentioned in this review: P. Bovo, L. Cordioli, D. De Paoli, M. Filippini, R. Franchi, A. Marabini, W. Piubello, B. Rosa, G. Tori, M. Valentini, P. Vallaperta, B. Vaona, G. Zamboni.

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Dobrilla, G., Cavallini, G., Vantini, I. et al. Critical evaluation of pancreatic function tests. La Ricerca in Clin. Lab. 5, 292–320 (1975). https://doi.org/10.1007/BF02910155

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