Diagnostic value of fecal chymotrypsin and trypsin assessment for detection of pancreatic disease

Ammann, Rudolf W.; Tagwercher, Ernst; Kashiwagi, Hirokazu; Rosenmund, H

doi:10.1007/bf02232955

Cited by 74 publications

(36 citation statements)

References 26 publications

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“…Lagerlof (1942) noted a linear relationship between the concentration of trypsin and amylase after injection of secretin, confirming Babkin's hypothesis that pancreatic enzymes were secreted 'in parallel'. 'Parallel' secretion of pancreatic enzymes was also reported in response to injections of secretin (Burton, Evans, Harper, Howat, Oleesky, Scott, and Varley, 1960) and of pancreozymin (Burton et al, 1960;Creutzfeldt, 1964;Rick, 1965;Sarles, Figarella, Prezelin, and Souville, 1966;Ammann, Tagwercher, Kashiwagi, and Rosenmund, 1968). On the other hand, Guth, Komarov, Shay, and Style (1956) found statistically significant day-to-day deviations from 'parallelism' in the enzyme response to food in dogs, while Worning and Mullertz (1966) (Burton et al, 1960) Gibbs (1950) showed that the secretion of amylase was sometimes grossly defective in normal infants, whose secretion of trypsin was normal, while Choi, Goldstein, Wirts, and Menduke (1967) recommended the measurement of trypsin because trypsin secretion could be abnormal when amylase secretion remained normal in patients with pancreatic disease.…”

Section: Discussionmentioning

confidence: 68%

The interrelationships of pancreatic enzymes in human duodenal aspirate

Goldberg¹,

Wormsley²

1970

Gut

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SUMMARY The interrelationships of proteolytic enzymes and amylase have been studied in the duodenal aspirate obtained from subjects with normal and abnormal pancreatic function during stimulation with secretin and pancreozymin. While the relationship of trypsin to chymotrypsin was independent of stimulus and presence of pancreatic disease the ratio of proteolytic enzymes to amylase rose when the degree of stimulation of the pancreas was increased. Patients with recent acute pancreatitis and-with chronic pancreatitis tended to have more severe impairment of secretion of proteolytic enzymes than of amylase. In routine tests of pancreatic function both proteolytic and non-proteolytic enzymes should be measured, both because an abnormal ratio may be of diagnostic significance and because the two different groups of enzymes provide mutual checks of the secretory capacity of pancreatic enzymes. with inguinal hernia or varicose veins); 20 patients with chronic duodenal ulcer; 13 patients who were tested either between three and six weeks or more than four months after attacks of acute pancreatitis; 10 patients with chronic pancreatitis; seven patients with anicteric pancreaticcarcinoma. All subjects were taking normal diets at the time of their tests. In each subject, one or more enzymes were estimated in duplicate or by more than one method.Techniques of intubation have been described previously (Wormsley, 1968). Amylase was estimated using the methods of Norby (Lagerlof, 1942) and of Bernfeld (Bernfeld and StuderPecha, 1947); proteolytic activity by the method of Gowenlock (1953); trypsin and chymotrypsin by the titrimetric method of Haverback, Dyce, Gutentag, and Montgomery (1963) using tosyl arginine methyl ester as substrate for trypsin, and acetyl tyrosine ethyl ester as substrate for chymotrypsin. Enzyme estimations were carried out within two to three days ofthetestonduodenal aspirate which had been diluted with an equal volume of glycerol and kept frozen (-20°C). The stability of random samples was tested over the course of one month.Each subject had two tests, during which pan-

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Section: Discussionmentioning

confidence: 68%

The interrelationships of pancreatic enzymes in human duodenal aspirate

Goldberg¹,

Wormsley²

1970

Gut

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“…On the whole there is good discrimination between normal and diseased glands (Cook et al, 1967;McCarthy and Brown, 1969 (Marks and Bank, 1963). Another such test is the estimation of faecal chymotrypsin and this can be performed on out-patients by an analysis of two stool samples per patient (Amman et al, 1968). On the whole these screening procedures have not been widely adopted.…”

Section: Pancreatic Function Testsmentioning

confidence: 99%

Gastric and Pancreatic Function Tests

Bouchier

1970

Ann Clin Biochem

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“…However, in the absence of morphological confirmation (pancre atic calcifications, pancreatic biopsies), the diagnosis of chronic pancreatitis can be based on appropriate and repeated pancreatic function studies as we emphasized in previous publications [2,4]. Persistent and progressive pancreatic exocrine and endocrine dysfunc tion is characteristic for chronic pancreatitis in contrast to reversible pancreatic dysfunc tion.…”

Section: Definitionsmentioning

confidence: 99%

Chronic Pancreatitis in Zurich, 1963–1972

Ammann¹,

Hammer²,

Fumagalli³

1973

Digestion

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Within the last 10 years, 102 cases of chronic pancreatitis have been observed, indicating that the incidence of chronic pancreatitis in Zurich is much higher than previously claimed. 84% of our patients are male with an average age of 43 years at onset. Pancreatic calcifications were demonstrated in 63%. Chronic alcoholism occurs in 62% of all patients. In our experience, ‘acute pancreatitis’ in chronic alcoholics is almost always the first manifestation of chronic relapsing pancreatitis, which is detected on the average 5 years after the first pain episode. Pancreatic exocrine insufficiency demonstrated by the CCK-secretin test was found in 99% of the patients tested, steatorrhea in 72%, and clinical or subclinical diabetes in 83%. 29 of the 102 patients died during the average follow-up time of 8.6 years. Death was due to complications of pancreatitis in about 30%. 35% of all patients were operated on for complications or for severe pain. But 36% of patients with chronic relapsing pancreatitis became painless spontaneously (‘secondary painless’ pancreatitis) after an average period of 6.6 years. In patients with ‘secondary painless’ pancreatitis, severe pancreatic insufficiency is predominantly present, indicating that chronic pancreatitis has the tendency to ‘burn out’ spontaneously.

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Diagnostic value of fecal chymotrypsin and trypsin assessment for detection of pancreatic disease

Cited by 74 publications

References 26 publications

The interrelationships of pancreatic enzymes in human duodenal aspirate

The interrelationships of pancreatic enzymes in human duodenal aspirate

Gastric and Pancreatic Function Tests

Chronic Pancreatitis in Zurich, 1963–1972

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