title: Postprandial protein metabolism but not a fecal test reveals protein malabsorption in patients with pancreatic exocrine insufficiency.
abstract: OBJECTIVE
  Pancreatic exocrine insufficiency (PEI) impairs fat absorption, but few data are available on protein absorption. We investigated this question in patients with chronic pancreatitis, both in the absence and presence of enzyme therapy, using a stable isotope sensitive method.
  
  
  METHODS
  Eleven patients with sustained PEI and regular enzyme substitution were investigated at hospital, after a washout period without enzyme substitution, and later after reintroduction of substitution. The digestibility and postprandial metabolism of dietary protein were characterized after the ingestion of a semi-synthetic single meal containing 20 g (15)N-labeled casein.
  
  
  RESULTS
  At baseline, 20 ± 8% of dietary nitrogen was transferred to the metabolic pools vs. 24.5 ± 7% under enzyme treatment (P = 0.04). After treatment, the transfer of dietary nitrogen tended to increase in plasma amino acids, and increased significantly in plasma proteins and the deamination pool. In contrast, the fecal excretion of dietary nitrogen did not demonstrate any treatment effect. In patients not receiving insulin for diabetes, the treatment stimulated insulin secretion.
  
  
  CONCLUSIONS
  Protein malabsorption was mostly undetectable using standard fecal tests. The study of the postprandial fate of dietary protein revealed a moderate increase of its transfer to metabolic pools after enzyme substitution.
authors: Gastroenterology Unit, CRNH IdF, AP-HP, University Paris 13, Hôpital Avicenne, Bobigny, France.
authors: Gheorghe
authors: G
authors: Airinei
authors: Claire
authors: C
authors: Gaudichon
authors: Cecile
authors: C
authors: Bos
authors: Cyriaque
authors: C
authors: Bon
authors: Nathalie
authors: N
authors: Kapel
authors: Bakhtiar
authors: B
authors: Bejou
authors: Jean Jacques
authors: JJ
authors: Raynaud
authors: Catherine
authors: C
authors: Luengo
authors: Thomas
authors: T
authors: Aparicio
authors: Philippe
authors: P
authors: Levy
authors: Daniel
authors: D
authors: Tome
authors: Robert
authors: R
authors: Benamouzig
mesh_terms: D000596:Amino Acids / Q000097:blood; D000641:Ammonia / Q000652:urine; D002364:Caseins / Q000493:pharmacokinetics; D003404:Creatinine / Q000652:urine; D004044:Dietary Proteins / Q000493:pharmacokinetics*; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood / Q000378:metabolism* / Q000652:urine; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007700:Kinetics; D008286:Malabsorption Syndromes / Q000097:blood / Q000378:metabolism* / Q000652:urine; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000378:metabolism*; D019518:Postprandial Period; D014508:Urea / Q000097:blood / Q000652:urine
chemical_list: D000596:Amino Acids; D002364:Caseins; D004044:Dietary Proteins; D000641:Ammonia; D014508:Urea; D003404:Creatinine