Hereditary pancreatitis laboratory findings: Difference between revisions
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===== (b) 72-hour quantitative fecal fat (Gold standard): ===== | ===== (b) 72-hour quantitative fecal fat (Gold standard): ===== | ||
* A quantitaive test that determines fecal fat excretion for over 24hrs. | * A quantitaive test that determines [[fecal]] fat excretion for over 24hrs. | ||
* Fecal fat excretion of >7g/day is diagnostic of malabsorption. | * [[Fecal]] fat excretion of >7g/day is diagnostic of [[malabsorption]]. | ||
* Patients with steatorrhea usually have an excretion of >10g of fat per day. | * Patients with [[steatorrhea]] usually have an [[excretion]] of >10g of fat per day. | ||
===== (c) Faecal elastase measurement (Test of choice): ===== | ===== (c) Faecal elastase measurement (Test of choice): ===== | ||
*The most sensitive and specific test for pancreatic exocrine dysfunction. | *The most sensitive and specific test for [[pancreatic]] [[exocrine]] dysfunction. | ||
*It can be done with a single random stool sample. | *It can be done with a single random stool sample. | ||
*The results are independent of pancreatic enzyme replacement therapy. | *The results are independent of pancreatic enzyme replacement therapy. | ||
*A value of less than 200 ug/g indicates pancreatic insufficiency.<ref name="UpTo">{{cite web |author=Freedman SD |url=http://www.uptodate.com/patients/content/topic.do?topicKey=~EzkfCtNwumVrg |title=Clinical manifestations and diagnosis of chronic pancreatitis in adults |format= |work=UpToDate |accessdate=}}</ref><ref name="pmid15285176">{{cite journal |vauthors=Keim V, Teich N, Moessner J |title=Clinical value of a new fecal elastase test for detection of chronic pancreatitis |journal=Clin. Lab. |volume=49 |issue=5-6 |pages=209–15 |year=2003 |pmid=15285176 |doi= |url=}}</ref><ref name="pmid12093988">{{cite journal |vauthors=Walkowiak J, Herzig KH, Strzykala K, Przyslawski J, Krawczynski M |title=Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis |journal=Pediatrics |volume=110 |issue=1 Pt 1 |pages=e7 |year=2002 |pmid=12093988 |doi= |url=}}</ref><ref name="pmid15343184">{{cite journal |vauthors=Borowitz D, Baker SS, Duffy L, Baker RD, Fitzpatrick L, Gyamfi J, Jarembek K |title=Use of fecal elastase-1 to classify pancreatic status in patients with cystic fibrosis |journal=J. Pediatr. |volume=145 |issue=3 |pages=322–6 |year=2004 |pmid=15343184 |doi=10.1016/j.jpeds.2004.04.049 |url=}}</ref> | *A value of less than 200 ug/g indicates [[pancreatic insufficiency]].<ref name="UpTo">{{cite web |author=Freedman SD |url=http://www.uptodate.com/patients/content/topic.do?topicKey=~EzkfCtNwumVrg |title=Clinical manifestations and diagnosis of chronic pancreatitis in adults |format= |work=UpToDate |accessdate=}}</ref><ref name="pmid15285176">{{cite journal |vauthors=Keim V, Teich N, Moessner J |title=Clinical value of a new fecal elastase test for detection of chronic pancreatitis |journal=Clin. Lab. |volume=49 |issue=5-6 |pages=209–15 |year=2003 |pmid=15285176 |doi= |url=}}</ref><ref name="pmid12093988">{{cite journal |vauthors=Walkowiak J, Herzig KH, Strzykala K, Przyslawski J, Krawczynski M |title=Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis |journal=Pediatrics |volume=110 |issue=1 Pt 1 |pages=e7 |year=2002 |pmid=12093988 |doi= |url=}}</ref><ref name="pmid15343184">{{cite journal |vauthors=Borowitz D, Baker SS, Duffy L, Baker RD, Fitzpatrick L, Gyamfi J, Jarembek K |title=Use of fecal elastase-1 to classify pancreatic status in patients with cystic fibrosis |journal=J. Pediatr. |volume=145 |issue=3 |pages=322–6 |year=2004 |pmid=15343184 |doi=10.1016/j.jpeds.2004.04.049 |url=}}</ref> | ||
=== Pancreatic function tests: === | === Pancreatic function tests: === | ||
===== (a) Direct/ Invasive tests: ===== | ===== (a) Direct/ Invasive tests: ===== | ||
* Direct tests are used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiology findings. | * Direct tests are used to assess [[pancreatic insufficiency]] in the early course of disease when patient has clinical symptoms but no radiology findings. | ||
* Direct tests involve pancreatic stimulation via meal or hormonal secretagogues and assessment of pancreatic secretions in the duodenal fluid. | * Direct tests involve pancreatic stimulation via meal or hormonal secretagogues and assessment of pancreatic secretions in the duodenal fluid. | ||
* Direct tests along with radiographic findings (pancreatic calcifications) are | * Direct tests along with radiographic findings (pancreatic calcifications) are still considered to be the gold standard for the diagnosis of hereditary pancreatitis.<ref name="pmid11276375">{{cite journal |vauthors=Boeck WG, Adler G, Gress TM |title=Pancreatic function tests: when to choose, what to use |journal=Curr Gastroenterol Rep |volume=3 |issue=2 |pages=95–100 |year=2001 |pmid=11276375 |doi= |url=}}</ref><ref name="pmid12641496">{{cite journal |vauthors=Chowdhury RS, Forsmark CE |title=Review article: Pancreatic function testing |journal=Aliment. Pharmacol. Ther. |volume=17 |issue=6 |pages=733–50 |year=2003 |pmid=12641496 |doi= |url=}}</ref><ref name="pmid15508057">{{cite journal |vauthors=Siegmund E, Löhr JM, Schuff-Werner P |title=[The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis] |language=German |journal=Z Gastroenterol |volume=42 |issue=10 |pages=1117–28 |year=2004 |pmid=15508057 |doi=10.1055/s-2004-813604 |url=}}</ref><ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref> | ||
* The limitation of direct tests is that they are costly and cumbersome.<ref name="pmid11276375">{{cite journal |vauthors=Boeck WG, Adler G, Gress TM |title=Pancreatic function tests: when to choose, what to use |journal=Curr Gastroenterol Rep |volume=3 |issue=2 |pages=95–100 |year=2001 |pmid=11276375 |doi= |url=}}</ref><ref name="pmid12641496">{{cite journal |vauthors=Chowdhury RS, Forsmark CE |title=Review article: Pancreatic function testing |journal=Aliment. Pharmacol. Ther. |volume=17 |issue=6 |pages=733–50 |year=2003 |pmid=12641496 |doi= |url=}}</ref><ref name="pmid15508057">{{cite journal |vauthors=Siegmund E, Löhr JM, Schuff-Werner P |title=[The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis] |language=German |journal=Z Gastroenterol |volume=42 |issue=10 |pages=1117–28 |year=2004 |pmid=15508057 |doi=10.1055/s-2004-813604 |url=}}</ref><ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref> | * The limitation of direct tests is that they are costly and cumbersome.<ref name="pmid11276375">{{cite journal |vauthors=Boeck WG, Adler G, Gress TM |title=Pancreatic function tests: when to choose, what to use |journal=Curr Gastroenterol Rep |volume=3 |issue=2 |pages=95–100 |year=2001 |pmid=11276375 |doi= |url=}}</ref><ref name="pmid12641496">{{cite journal |vauthors=Chowdhury RS, Forsmark CE |title=Review article: Pancreatic function testing |journal=Aliment. Pharmacol. Ther. |volume=17 |issue=6 |pages=733–50 |year=2003 |pmid=12641496 |doi= |url=}}</ref><ref name="pmid15508057">{{cite journal |vauthors=Siegmund E, Löhr JM, Schuff-Werner P |title=[The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis] |language=German |journal=Z Gastroenterol |volume=42 |issue=10 |pages=1117–28 |year=2004 |pmid=15508057 |doi=10.1055/s-2004-813604 |url=}}</ref><ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref> | ||
* Direct tests include: | * Direct tests include: | ||
| Line 45: | Line 45: | ||
===== (b) Indirect/ Non-invasive tests: ===== | ===== (b) Indirect/ Non-invasive tests: ===== | ||
* Indirect tests are used to assess the complications of chronic pancreatitis. | * Indirect tests are used to assess the complications of chronic hereditary pancreatitis. | ||
* Indirect tests include: | * Indirect tests include: | ||
** Faecal chymotrypsin, PABA-, pancreolauryl- | ** Faecal chymotrypsin, PABA-, pancreolauryl- | ||
** Faecal elastase test | ** Faecal elastase test | ||
* Indirect tests are not sensitive to assess pancreatic insufficiency in the early course of disease.<ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref><ref name="pmid11179244">{{cite journal |vauthors=Etemad B, Whitcomb DC |title=Chronic pancreatitis: diagnosis, classification, and new genetic developments |journal=Gastroenterology |volume=120 |issue=3 |pages=682–707 |year=2001 |pmid=11179244 |doi= |url=}}</ref> | * Indirect tests are not sensitive to assess [[pancreatic insufficiency]] in the early course of disease.<ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref><ref name="pmid11179244">{{cite journal |vauthors=Etemad B, Whitcomb DC |title=Chronic pancreatitis: diagnosis, classification, and new genetic developments |journal=Gastroenterology |volume=120 |issue=3 |pages=682–707 |year=2001 |pmid=11179244 |doi= |url=}}</ref> | ||
=== Genetic testing : === | === Genetic testing : === | ||
Revision as of 15:51, 10 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
Laboratory Findings
- Serum amylase and lipase are usually normal but may be slightly elevated (neither diagnostic nor prognostic).
- Serum bilirubin and alkaline phosphatase levels may be elevated in case of intra-pancreatic biliary duct obstruction.
- The following lab tests are usually normal:
Fecal tests:
(a) Sudan staining of feces:
- A non-specific, qualitative test that is no longer used for the diagnosis of steatorrhea.
(b) 72-hour quantitative fecal fat (Gold standard):
- A quantitaive test that determines fecal fat excretion for over 24hrs.
- Fecal fat excretion of >7g/day is diagnostic of malabsorption.
- Patients with steatorrhea usually have an excretion of >10g of fat per day.
(c) Faecal elastase measurement (Test of choice):
- The most sensitive and specific test for pancreatic exocrine dysfunction.
- It can be done with a single random stool sample.
- The results are independent of pancreatic enzyme replacement therapy.
- A value of less than 200 ug/g indicates pancreatic insufficiency.[1][2][3][4]
Pancreatic function tests:
(a) Direct/ Invasive tests:
- Direct tests are used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiology findings.
- Direct tests involve pancreatic stimulation via meal or hormonal secretagogues and assessment of pancreatic secretions in the duodenal fluid.
- Direct tests along with radiographic findings (pancreatic calcifications) are still considered to be the gold standard for the diagnosis of hereditary pancreatitis.[5][6][7][8]
- The limitation of direct tests is that they are costly and cumbersome.[5][6][7][8]
- Direct tests include:
- Secretin stimulation test
- Pancreozymin-secretin test
- Secretin stimulation test is considered the gold standard functional test for diagnosis of chronic pancreatitis.
(b) Indirect/ Non-invasive tests:
- Indirect tests are used to assess the complications of chronic hereditary pancreatitis.
- Indirect tests include:
- Faecal chymotrypsin, PABA-, pancreolauryl-
- Faecal elastase test
- Indirect tests are not sensitive to assess pancreatic insufficiency in the early course of disease.[8][10]
Genetic testing :
In Symptomatic patients:
In Asymptomatic patients:
References
- ↑ Freedman SD. "Clinical manifestations and diagnosis of chronic pancreatitis in adults". UpToDate.
- ↑ Keim V, Teich N, Moessner J (2003). "Clinical value of a new fecal elastase test for detection of chronic pancreatitis". Clin. Lab. 49 (5–6): 209–15. PMID 15285176.
- ↑ Walkowiak J, Herzig KH, Strzykala K, Przyslawski J, Krawczynski M (2002). "Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis". Pediatrics. 110 (1 Pt 1): e7. PMID 12093988.
- ↑ Borowitz D, Baker SS, Duffy L, Baker RD, Fitzpatrick L, Gyamfi J, Jarembek K (2004). "Use of fecal elastase-1 to classify pancreatic status in patients with cystic fibrosis". J. Pediatr. 145 (3): 322–6. doi:10.1016/j.jpeds.2004.04.049. PMID 15343184.
- ↑ 5.0 5.1 Boeck WG, Adler G, Gress TM (2001). "Pancreatic function tests: when to choose, what to use". Curr Gastroenterol Rep. 3 (2): 95–100. PMID 11276375.
- ↑ 6.0 6.1 Chowdhury RS, Forsmark CE (2003). "Review article: Pancreatic function testing". Aliment. Pharmacol. Ther. 17 (6): 733–50. PMID 12641496.
- ↑ 7.0 7.1 Siegmund E, Löhr JM, Schuff-Werner P (2004). "[The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis]". Z Gastroenterol (in German). 42 (10): 1117–28. doi:10.1055/s-2004-813604. PMID 15508057.
- ↑ 8.0 8.1 8.2 Ammann RW (2006). "Diagnosis and management of chronic pancreatitis: current knowledge". Swiss Med Wkly. 136 (11–12): 166–74. doi:2006/11/smw-11182 Check
|doi=value (help). PMID 16633964. - ↑ 9.0 9.1 Ketwaroo G, Brown A, Young B, Kheraj R, Sawhney M, Mortele KJ, Najarian R, Tewani S, Dasilva D, Freedman S, Sheth S (2013). "Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis". Am. J. Gastroenterol. 108 (8): 1360–6. doi:10.1038/ajg.2013.148. PMC 5388854. PMID 23711627.
- ↑ Etemad B, Whitcomb DC (2001). "Chronic pancreatitis: diagnosis, classification, and new genetic developments". Gastroenterology. 120 (3): 682–707. PMID 11179244.