Pancreatic function testing

Abstract

SUMMARYPancreatic function tests are most commonly used to diagnose chronic pancreatitis. These tests include tests which document exocrine or endocrine gland insufficiency and tests which instead measure gradations of decreased secretory capacity. The tests in the former category generally become abnormal when advanced, longstanding chronic pancreatitis is present. Tests in the latter category, however, have the potential to detect chronic pancreatitis at an earlier stage than other available diagnostic tests, including commonly used imaging tests such as computed tomography and endoscopic retrograde cholangiopancreatography. This potential advantage of diagnostic sensitivity is, however, counterweighed by the fact that these tests which measure stimulated secretory capacity are only available at a very few referral centres. This article will review the variety of pancreatic function tests and describe their rationale, accuracy, cost, and clinical usefulness.

Italian consensus guidelines for chronic pancreatitis

“…Such tests are sensitive but poorly specific, i.e. they are not diagnostic [105,106]. Conversely, tubeless tests of pancreatic function can detect severe exocrine insufficiency only [107][108][109].…”

Hereditary chronic pancreatitis

“…The use of invasive function tests (secretin test, pancreozymin-secretin test) is declining over the last years. In recent reviews it was stated that invasive function tests in combination with pancreatic calcification are still the gold standard in the diagnosis of chronic pancreatitis, but these tests are laborious and costly [23][24][25][26]. Non-invasive tests (faecal chymotrypsin, PABA-, pancreolauryl-and faecal elastase test) are insufficient for the detection of minor or moderate insufficiency as a result of their restricted sensitivity compared to the pancreozymin-secretin test.…”

Use of a Mutilumen Catheter to Assess the Bioavailability of an Enteric- Coated High-Buffered Pancrelipase Formulation in Patients with Exocrine Pancreatic Insufficiency

“…Based on the underlying cause of pancreatic insufficiency, the levels of these secretions will vary considerably from one individual to another. It also has been reported that patients may be deficient in only some enzymes and not others [24].…”

“…A spot fecal elastase 1 test from a stool sample was used to confirm pancreatic enzyme insufficiency in patients [22]. Subjects were selected for the study only if the spot fecal elastase 1 was <200 µg/g at the time of screening [23][24][25].…”

“…Most tests of pancreatic function are only accurate in advanced disease [24]. The normal pancreas secrete 1-2 L of water, bicarbonate, digestive enzymes and other proteins and minerals per day under complex regulatory mechanisms [26].…”