title: Use of pancreatic Schilling test to determine efficiency of pancreatic enzyme delivery in pancreatic insufficiency.
abstract: The pancreatic Schilling test (PST), a noninvasive, sensitive pancreatic function test, was studied to determine its ability to detect pancreatic proteolytic enzyme replacement in patients with pancreatic insufficiency. Seven subjects with well-documented pancreatic insufficiency and an abnormal PST consistent with pancreatic insufficiency were studied with three enzyme regimens: (1) Viokase (four tablets), (2) Pancrease (three capsules), and (3) Pancrease (10 capsules). The effect of cimetidine on the results of the PST with high-dose Pancrease was also determined in two subjects with pancreatic insufficiency and in two normal volunteers. The results of the investigation demonstrate that the PST is a sensitive noninvasive test for the presence of orally administered proteolytic enzymes in subjects with pancreatic insufficiency and in normals. Furthermore, the studies illustrate that the administration of enzymes in a form of enteric-coated microspheres does not enhance the delivery of proteolytic enzymes to the small intestine when compared to conventional high-dose enzyme replacement. Cimetidine appears to decrease the inactivation of the proteolytic enzymes in enteric-coated microspheres, suggesting that a low pH in the small intestine and stomach are responsible for the poor delivery of the enzymes into the small intestine.
authors.affiliation: Northport Veterans Administration Medical Center, New York.
authors.forename: W R
authors.initials: WR
authors.lastname: Brugge
authors.forename: H J
authors.initials: HJ
authors.lastname: Goldberg
authors.forename: C A
authors.initials: CA
authors.lastname: Burke
authors.forename: B J
authors.initials: BJ
authors.lastname: Depping
mesh_terms: D000328:Adult; D000368:Aged; D003692:Delayed-Action Preparations; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy* / Q000201:enzymology; D005750:Gastric Juice / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007421:Intestine, Small / Q000378:metabolism; D008049:Lipase / Q000627:therapeutic use*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D010184:Pancreatic Extracts / Q000627:therapeutic use*; D010186:Pancreatic Function Tests; D010194:Pancreatin / Q000008:administration & dosage / Q000627:therapeutic use*; D020799:Pancrelipase; D012463:Saliva / Q000378:metabolism; D012546:Schilling Test; D014357:Trypsin / Q000032:analysis
chemical_list: D003692:Delayed-Action Preparations; D010184:Pancreatic Extracts; D020799:Pancrelipase; D010194:Pancreatin; D008049:Lipase; D014357:Trypsin