Duodenal secretion of phospholipase A₂, amylase, and bicarbonate in chronic pancreatitis

Abstract:

Phospholipase A₂ has been suggested to be involved in the pathogenesis and pathophysiology of acute pancreatitis. We determined phospholipase A₂ and amylase activities in duodenal juice collected during a secretin test from 30 consecutive patients who were suspected to have chronic pancreatitis or biliary disease. The patients underwent endoscopic retrograde cholangiopancreatography (ERCP) the following day. In the 8 patients with ERCP findings of advanced chronic pancreatitis, the mean outputs of phospholipase A₂, amylase, and bicarbonate were reduced by 74%, 72%, and 60% compared to the respective values in the 13 (control) patients without a diagnosis of any pancreatic disorder or jaundice. In the 3 patients with recurrent pancreatitis but normal ERCP findings and in the 6 patients with jaundice the output values were not significantly reduced compared to those in the patients without any pancreatic disorder or jaundice. The outputs of amylase and phospholipase A₂ were not significantly interrelated, whereas the outputs of phospholipase A₂ and bicarbonate correlated well. Receiver characteristic (ROC) curves confirmed the high specificity and sensitivity of phospholipase A₂ or bicarbonate output in patients with ERCP findings of advanced chronic pancreatitis compared to those with no changes in pancreatic ducts, with similar probability values of 0.880 ± 0.111 (SEM), compared to the respective lower value of amylase, 0.676 ± 0.118. Phospholipase A₂ and bicarbonate output proved of equal value as markers of chronic pancreatitis and were superior to amylase output in the secretin test.