Determination of faecal chymotrypsin concentration and 72-hour faecal chymotrypsin output in the detection of pancreatic steatorrhoea.
In 96 consecutive patients who underwent a 72-h faecal fat determination because of suspected nutrient malassimilation (maldigestion and/or malabsorption) faecal chymotrypsin (F-Chym) was estimated with a commercial photometric test (Monotest Chymotrypsin), comparing F-Chym concentrations in the first 24-h stool with the total 72-h F-Chym output. In the first 24-h faeces, the F-Chym concentration, calculated as a mean of three random samples, did not significantly differ from a single value obtained after homogenization. In known pancreatic disease, a F-Chym concentration less than 3.0 U/g wet faeces distinguished well between steatorrhoic patients (n = 12) and nonsteatorrhoic (n = 13) (positive predictive value (PV), 91%; negative PV, 86%) but was less suitable as a screening test for pancreatic steatorrhoea in the unselected patient group (positive PV, 61%; negative PV, 98%). Although the estimation of 72-h F-Chym output could differentiate between various subgroups of patients to a certain extent, the positive PV for discovery of pancreatic steatorrhoea in a single patient was low. Four patients had excessively high F-Chym output and increased bile acid excretion after ileal resection (n = 3) and radiation ileitis (n = 1), respectively, possibly indicating the removal of an inhibitory mechanism of pancreatic and biliary secretion in these conditions.
Stockbrügger
R W
RW
Dept. of Gastroenterology, Academic Hospital, Maastricht, The Netherlands.
Armbrecht
U
U
Müller
E
E
Heusinger
A
A
D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis* / Q000209:etiology; D002918:Chymotrypsin / Q000032:analysis*; D010188:Exocrine Pancreatic Insufficiency / Q000150:complications*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000175:diagnosis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015431:Weight Loss
D002918:Chymotrypsin