p-Aminobenzoic acid as an alternative chemical biopsy agent for human hepatic UDP-glucose.

p-Aminobenzoic acid (PABA) was evaluated for noninvasive sampling of UDP-glucose in the liver. Six healthy subjects ingested 550 mg PABA during a breakfast meal. Urine was collected 0-2 and 2-4 h after PABA ingestion. N-acetyl PABA glucuronide (NAPG) was identified with 522 ± 212 µmol recovered in the 2-4 h urines. One of the subjects ingested 2 g of 98% [U-2H7]glucose alongside PABA and the NAPG was analyzed for positional 2H-enrichment by 2H NMR following derivatization to 5-O-acetyl monoacetone glucuronolactone. In conclusion, PABA is an effective agent for the chemical biopsy of hepatic UDP-glucose in humans.

Association of fatty pancreas with pancreatic endocrine and exocrine function.

AIM: The purpose of this study was to clarify whether fatty pancreas might lead to impaired pancreatic endocrine or exocrine function. MATERIAL AND METHODS: The study involved 109 participants who had undergone the glucagon stimulation test and N-benzoyl-L-tyros-p-amino benzoic acid (BT-PABA) test to assess pancreatic function as well as unenhanced abdominal computed tomography (CT). Pancreatic endocrine impairment was defined as ΔC peptide immunoreactivity less than 2 [mmol/L] in the glucagon stimulation test, and pancreatic exocrine impairment was defined as a urinary PABA excretion rate less than 70% on the BT-PABA test. We defined as the mean CT value of pancreas / CT value of spleen (P/S ratio) as a marker to assess fatty pancreas. We analyzed the association between fatty pancreas and pancreatic impairment using the logistic regression model. The odds ratio (OR) is shown per 0.1 unit. RESULTS: Pancreatic endocrine function was impaired in 33.0% of the participants, and 56.9% of those were regarded as having pancreatic exocrine impairment. The P/S ratio was significantly correlated with pancreatic endocrine impairment in univariate analysis (OR = 0.61, 95% confidence interval (CI) = 0.43-0.83, P = 0.0013) and multivariate analysis (OR = 0.38, 95% CI = 0.22-0.61, P < .0001) for all participants. Similar significant relationships were observed in both univariate (OR = 0.70, 95% CI = 0.49-0.99, P = 0.04) and multivariate (OR = 0.39, 95% CI = 0.21-0.66, P = 0.0002) analyses for the participants without diabetes (n = 93). The amount of pancreatic fat was not associated with exocrine impairment in univariate analysis (OR = 0.80, 95% CI = 0.59-1.06, P = 0.12). CONCLUSION: Fatty pancreas was associated with pancreatic endocrine impairment but did not have a clear relationship with pancreatic exocrine impairment.

Determination of 2-ethylhexyl 4-(dimethylamino) benzoate using membrane-assisted liquid-liquid extraction and gas chromatography-mass spectrometric detection.

A flow-cell for micro-porous membrane liquid-liquid extraction with a sheet membrane was used to extract 2-ethylhexyl 4-(dimethylamino) benzoate (EDB) from urine of solar-cream users and spiked wine samples. The cell enabled the target analyte to be extracted from 7.9 mL of donor solution into 200 microL of acceptor solution (decane). After extraction, the acceptor solution was transferred to a micro-vial for GC-MS analysis without derivation. In this work, variables affecting the enrichment factor were also studied, such as organic solvent, extraction time, recirculation flow of the donor solution through the donor chamber, presence of potassium chloride and ethanol in the donor solution and pH. The method has been evaluated in terms of linearity, sensitivity, precision, limits of detection and quantification and extraction efficiency. Limits of quantification were 1 and 3 microg L(-1) EDB for urine and wine, respectively. Quantitative analysis has been carried out by applying the method of standard additions. Within- and between-day relative standard deviations were lower than 12% and 20%, respectively. EDB was found in the urine of users of cream containing EDB in the concentration interval 1.2-7.2 microg L(-1). Therefore, this provides evidence of EDB dermal absorption and subsequent excretion through the urinary tract. EDB was not found in the analysed wine samples.

The outcome of a long-term follow-up of pancreatic function after recovery from acute pancreatitis.

CONTEXT: It is generally assumed that pancreatic function recovers completely after mild but not after severe acute pancreatitis. OBJECTIVE: To evaluate both pancreatic function and quality of life in patients who had recovered from acute pancreatitis in a long-term follow-up study. PARTICIPANTS: Thirty-four patients (mean age: 56 years) who had recovered from biliary (n=26) or post ERCP (n=8) acute pancreatitis. The mean time after the event was 4.6 years. MAIN OUTCOME MEASURES: Pancreatic function was evaluated by fecal fat excretion, urinary 4-aminobenzoic acid (PABA) recovery, oral glucose tolerance test and pancreatic polypeptide (PP) secretion. In addition, the quality of life was measured by the gastrointestinal quality of life index (GIQLI). RESULTS: Of the 34 patients, 22 (65%) had mild and 12 (35%) had severe acute pancreatitis. Exocrine insufficiency (fecal fat greater than 7 g/24h and/or urinary PABA recovery less than 50%) was present in 22 (65%) patients: in 10 (83%) after severe and in 12 (55%) after mild acute pancreatitis, respectively (P=0.140). Endocrine insufficiency was present in 12 patients (35%): 7 (32%) mild versus 5 (42%) severe acute pancreatitis; P=0.711. the quality of life was significantly impaired after acute pancreatitis, (P=0.024). No significant relationship was found between the severity of the pancreatitis and impairment of the quality of life (P=0.604). CONCLUSION: In a significant proportion of patients who had recovered from acute pancreatitis, exocrine and endocrine functional impairment was found. This finding is not confined only to patients after severe acute pancreatitis. Routine evaluation of pancreatic function after acute pancreatitis should be considered.

Chronic pancreatitis: relation between function and morphology.

BACKGROUND: In our department, we routinely use a combined exocrine-endocrine function test to evaluate the pancreatic function in chronic pancreatitis i.e. urinary para amino benzoic acid (PABA) recovery and pancreatic polypeptide secretion in response to a meal and glucose tolerance test. AIM: To study the relationship between changes in morphology and exocrine/endocrine function in patients with chronic pancreatitis. PATIENTS AND METHODS: In 103 patients with chronic pancreatitis seen by our department for evaluation of pancreatic function between 1989 and 1999, we retrospectively analysed the correlation between morphology (Cambridge-score) and function. Furthermore the differences in presentation, function and morphology between patients with alcohol-induced chronic pancreatitis and idiopathic chronic pancreatitis were evaluated. RESULTS: Significant correlation were found for both PABA recovery and pancreatic polypeptide secretion with morphologic score, respectively r = -0.205 (P = 0.037) and r = -0.209 (P = 0.031), but not with endocrine function. The correlation between morphology and PABA recovery or pancreatic polypeptide secretion was observed in the subgroup with alcohol-induced chronic pancreatitis but not in those with idiopathic chronic pancreatitis. Pain is a prominent symptom of chronic pancreatitis. Pain was more frequent and more severe in patients suffering from chronic pancreatitis caused by alcohol or idiopathy. CONCLUSIONS: Morphology and exocrine function correlate in patients with alcohol-induced chronic pancreatitis but not in patients with chronic pancreatitis. When compared to patients with chronic pancreatitis of idiopathic origin, patients with alcoholic origin show differences in presentation and morphology but not in function.

Outcomes and indications of segmental pancreatectomy. Comparison with distal pancreatectomy.

BACKGROUND/AIM: To preserve pancreatic function, segmental pancreatectomy has been proposed for benign or low-malignancy tumors in the pancreatic body. Indications for the procedure, however, are still controversial. METHODS: In this study, we investigated the advantages and disadvantages of segmental pancreatectomy compared with distal pancreatectomy and subsequently determined indications for segmental pancreatectomy. RESULTS: The distal pancreatectomy patients had shorter operation times, lower incidence of operative complications, and shorter hospital stays compared to segmental pancreatectomy patients. Endocrine function in distal pancreatectomy patients deteriorated compared to that of segmental pancreatectomy patients. The postoperative 75-gram oral glucose tolerance test showed a diabetic pattern in 3 of 7 distal pancreatectomy patients, whereas none of the segmental pancreatectomy patients became diabetic after surgery. The relation between the length of the removed pancreas and plasma glucose at 2 h after the 75-gram glucose intake showed a significant correlation. CONCLUSION: According to our results, if the length of removed pancreas is longer than 12 cm, the patients will have a risk of acquiring diabetes. In those cases, the segmental pancreatectomy should be considered.

Pancreatic polypeptide secretion in patients with chronic pancreatitis and after pancreatic surgery.

AIM: We investigated polypeptide (PP) secretion under basal conditions, in response to bombesin infusion and to meal ingestion in patients with chronic pancreatitis (CP) and patients after different types of pancreatic surgery. METHODS: Included were patients with CP without (n = 20) and with (n = 30) exocrine pancreatic insufficiency, patients after duodenum preserving resection of the head of the pancreas (DPRHP; n = 20), after Whipple's procedure (n = 19), following distal pancreatectomy (DP; n = 12), and healthy controls (n = 36). RESULTS: In CP patients basal and bombesin stimulated PP levels were significantly (p<0.01) reduced compared to controls only when exocrine insufficiency was present. Meal-stimulated PP secretion was significantly (p<0.01-0.05) reduced in CP patients both with and without exocrine insufficiency. Plasma PP peak increments after bombesin and meal ingestion correlated significantly with exocrine function. Basal PP, meal, and bombesin-stimulated PP secretion had low sensitivities of 22%, 42%, and 60% respectively, in detecting chronic pancreatitis. In patients after pancreatic surgery that included pancreatic head resection (DPRHP or Whipple operation) basal and stimulated PP secretion were significantly (p<0.01-0.05) reduced. CONCLUSION: Basal and meal or bombesin-stimulated PP levels are significantly reduced in patients with CP only when exocrine insufficiency is present. Determination of plasma PP levels has low sensitivity and is not useful in detecting chronic pancreatitis without exocrine insufficiency. In patients after pancreatic surgery, PP secretion is dependent on the type of operation (head vs tail resection).

In vivo evaluation of long-term patency of pancreaticoenterostomy after Whipple operation.

BACKGROUND/AIMS: The aim of this study was to examine the long-term patency of pancreaticoenterostomy in vivo. METHODOLOGY: Evaluation of the patency of the pancreaticoenterostomy was conducted in 12 patients who had undergone the Whipple procedure. After intravenous infusion of secretin (1 microgram/kg), the diameter of the pancreatic duct was taken at 1, 3, 5, 15, 20 and 25 min by means of ultrasonography. We estimated the degree of anastomotic stricture by the maximal dilatation ratio [MDR: Maximal value (Dmax)/basal value (D0)]. The patients underwent pancreatic exocrine function tests before and 1-2 years after surgery. RESULTS: Maximal ductal dilatation was noted from 3 min of 15 min after secretin infusion, thereafter ductal diameter gradually diminished and returned to its basal value at 25 min. Maximal dilatation ratio ranged from 1.3-2.5, 1.7 +/- 0.12. There was a good negative relationship between the maximal dilatation ratio and pancreatic exocrine function. Based on the result of chi 2 analysis, we judged anastomotic stricture to be present in 2 patients with maximal dilatation ratio above 2.0. In these 2 patients, preoperative pancreatic exocrine function recoveries were 69 and 48%, while postoperative pancreatic exocrine function recoveries were 13.8 and 18%, respectively. In the other 10 patients, there was no difference between preoperative and postoperative value of pancreatic exocrine function. CONCLUSIONS: The present method permits safe and non-invasive evaluation of the patency of pancreaticoenterostomy.

Intraoperative radiation enhances decline of pancreatic exocrine function after pancreatic head resection.

Intraoperative radiation therapy has been introduced to improve survival rates after resection of biliopancreatic cancer. Early and late effects of intraoperative radiation on the exocrine and endocrine functions of the residual pancreas were examined in 54 patients with pancreatic head resection. Of the 54 patients, 20 underwent intraoperative radiation (A group) and the other 34 did not (B group). Fasting blood sugar level, a 120-min value of the 75-g oral glucose tolerance test, N-benzol-L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion value (a pancreatic exocrine function test), and amount of postoperative pancreatic juice drainage were compared between groups A and B at preoperative and early and late postoperative times. Fasting blood sugar level and a 120-min value of the 75-g oral glucose tolerance test (OGTT) showed no change at the early (<2 months) postoperative period of the two groups. At the late (>6 months) postoperative period, fasting blood sugar showed no alteration, while the 75-g OGTT 120-min value increased compared to the preoperative level in both groups. In the group A, the 75-g OGTT 120-min value at the late postoperative period was significantly higher than those at the preoperative and early postoperative periods (289.4 +/- 104.9 vs 193.0 +/- 58.2 mg/dl, P = 0.0198 and 289.4 +/- 104.9 vs 184.4 +/- 104.9 mg/dl, P = 0.0285). Preoperative BT-PABA excretion value was not different between the two groups. It decreased at the early postoperative period and returned to the preoperative level at the late postoperative period in both the groups. The decline of BT-PABA in group A was 23 +/- 21%, which was significantly larger than 11 +/- 24% in group B. The total amount of postoperative pancreatic juice drainage from postoperative days (POD) 4-13 in group A was about half as much as that in group B (720.8 +/- 916.4 vs 1433.8 +/- 962.1 ml, P = 0.0128). Univariate and multivariate regression analysis of factors concerning the decline of BT-PABA values at the early postoperative period showed that intraoperative radiation was a significant independent determinant. In conclusion, these results suggest that intraoperative radiation causes significant deterioration of pancreatic exocrine function at the early postoperative period. Intraoperative radiation for resectable periampullary carcinoma should be reappraised based on the decline of the pancreatic exocrine function as well as the improvement of the survival curve.

Changes in pancreatic function after pancreatoduodenectomy.

BACKGROUND: The objective of this study was to compare the alterations in pancreatic function after pancreatoduodenectomy between malignant and benign diseases. METHODS: In 34 patients who underwent pancreatoduodenectomy for pariampullary cancer (malignant group; n = 18) and benign pancreatic disorders (benign group; n = 16), exocrine and endocrine functions were analyzed before surgery, at a short-term period (< or = 2 months), and at a long-term period (>12 months) after surgery. Assessment was based on the BT-PABA excretion test, fasting blood sugar level, and oral glucose tolerance test. RESULTS: Compared with the preoperative level, urinary PABA excretion rate in the malignant group significantly decreased on short-term follow-up but recovered on long-term follow-up. However, that in the benign group increased on long-term follow-up without showing a short-term decline. Diabetes mellitus was present in 11 (61%) of the 18 patients in the malignant group and 6 (38%) of the 16 in the benign group before surgery. Glucose tolerance improved in 6 (55%) of the 11 patients in the malignant group but in only 1 (17%) of the 6 in the benign group shortly after surgery. In the benign group, 3 (30%) of 10 patients with normal preoperative glucose tolerance became diabetic after surgery, while no patient in the malignant group developed diabetes on short-term follow-up. CONCLUSIONS: Surgeons should pay attention to exocrine pancreatic function in patients with a periampullary cancer and to glucose metabolism in patients with benign disease over the short-term period after pancreatoduodenectomy.

Short-term and long-term pancreatic exocrine and endocrine functions after pancreatectomy.

Exocrine and endocrine functions of the pancreas were assessed in 44 Japanese patients who underwent pancreatic head resection. Functions were analyzed comparing levels before surgery, at a short-term follow-up (<2 months), and at a long-term follow-up (12-31 months). The N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion test, fasting blood sugar (FBS) level, and oral glucose tolerance test (OGTT) were used to determine pancreatic function. The patients were divided into three groups according to the size of the main pancreatic duct: group 1, 15 patients with a normal sized duct (< or =3 mm); group 2, 20 with a moderately dilated duct (>3 mm, <10 mm); and group 3, 9 with a markedly dilated duct (> or =10 mm). The mean BT-PABA value (6-hr urinary PABA recovery rate) in group 1 showed no change during the postoperative period. In contrast, the BT-PABA values in groups 2 and 3 had dropped by the short-term follow-up and returned to the preoperative level by the long-term examination. FBS and 120-min OGTT levels were not different between the three groups preoperatively. Although these values showed no change in all the three groups at the short-term measurements, the FBS in group 3 and 120-min levels in all the three groups had increased at the long-term. These findings suggest that exocrine pancreatic function shows a short-term deterioration in patients with a dilated pancreatic duct but recovers to the preoperative level over the long term after pancreatic head resection. Endocrine insufficiency, however, may occur at a long-term point after surgery irrespective of the preoperative pancreatic ductal dilatation.

Validation with biological markers for food intake of a dietary assessment method used by Swedish women with three different dietary preferences.

OBJECTIVES: To validate a dietary assessment method, a 4-day food record together with a duplicate portion technique, with biological markers for food intake. DESIGN: Four days of duplicate portions were collected in parallel with food recording. A 24-h urine sample and the faeces corresponding to the food intake (using a coloured marker) were collected. Completeness of urine and faeces collections was assessed using para-aminobenzoic acid (PABA) in urine and cadmium in faeces, respectively. Biomarkers of food intake (energy, protein, fibre, sodium, potassium, calcium) were measured in urine and faeces. SETTING: Swedish west coast. SUBJECTS: Non-smoking Swedish women, 20-50 years of age, consuming a mixed diet (n = 34), a mixed diet rich in shellfish (n = 17) or a vegetarian/high-fibre diet (n = 23). RESULTS: The average ratio (food intake according to the dietary assessment methods/ biological marker) for protein, sodium, potassium and calcium was 0.86. This indicates an underestimation of the food intake by approximately 15%. The ratio of stated fibre intake to biological marker was 1.20 for the mixed diet and the vegetarian diet group, indicating an overestimation by approximately 20%. CONCLUSIONS: The underestimation of the intake of protein, sodium, potassium and calcium by all three groups and the overestimation of the fibre intake by two groups indicate that underreporting is selective to certain nutrients and foods and to various groups of people. The two dependent dietary assessment methods were equally good in measuring protein intake, which indicates that the women recorded what they actually duplicated.

Biochemical tests in the diagnosis of chronic pancreatitis and in the evaluation of pancreatic insufficiency.

Chronic pancreatitis (adults) and cystic fibrosis (children) are the most common diseases leading to exocrine pancreatic insufficiency that, when reduced to < 5% of normal function, is characterised by steatorrhoea. The pathogenesis of the former condition is outlined, and recent concepts are emphasized. Biochemical tests to detect pancreatic insufficiency and to identify pancreatic disease as the cause of steatorrhoea include: serum enzyme tests (lipase, amylase, trypsin); stool chymotrypsin; isotopic tests based upon the assimilation of [14C] lipids and starch or excretion of the isotope as breath CO2, as well as the dual-labelled Schilling test; oral function tests utilising substrates hydrolysed by pancreatic enzymes such as benzoyl tyrosyl-p-aminobenzoic acid and fluorescein dilaurate; and duodenal intubation studies following meal-induced or hormonal stimulation of the pancreas. The rationale for these tests and the cumulative clinical experience of their utility are reviewed. A recommended diagnostic strategy is briefly presented. The role of various biochemical procedures to evaluate the efficacy of pancreatic enzyme replacement therapy is also described.

Postprandial exocrine pancreatic function during long-term treatment with the somatostatin analogue SMS 201-995 in acromegalic patients.

Long-term treatment with the somatostatin analogue SMS 201-995 (SMS) might impair exocrine pancreatic function, secretion of cholecystokinin (CCK) and pancreatic polypeptide (PP), and pancreatic size. In five acromegalics on chronic treatment with SMS, we investigated postprandial 6-h urinary excretion of p-aminobenzoic acid (PABA) and p-aminosalicylic acid (PAS) after s.c. injection of 100 micrograms SMS or placebo and after ingestion of 2 mmol nBT-PABA and 2 mmol PAS. In the acromegalics, urinary PABA/PAS ratio (reflecting exocrine pancreatic function) after SMS was similar to that after placebo (P greater than 0.10) and higher than in healthy volunteers (n = 8, P = 0.05). The initial inhibition of plasma CCK secretion by SMS was cancelled during the 3rd h after the meal, whereas PP release remained completely abolished. Pancreatic size as measured by ultrasonography, was not reduced in seven acromegalics compared with 14 healthy volunteers. It is concluded that despite a blunted release of the trophic hormone CCK, long-term treatment with SMS 201-995 neither induces an abnormally small pancreas nor deterioration of postprandial exocrine pancreatic function in patients with acromegaly.

Pancreatic exocrine function after a sutureless pancreatico-jejunostomy following pancreaticoduodenectomy.

Exocrine pancreatic function was measured in 14 patients after pancreaticoduodenectomy for periampullary neoplasms in order to assess the patency of a sutureless pancreatico-enteric anastomosis. Pancreatic function was examined by the p-aminobenzoic acid/p-aminosalicylic acid (PABA/PAS) test 3-160 months after operation and compared with age- and sex-matched controls. There were no significant differences between mean (s.e.m.) serum PABA concentrations 3 h after ingestion of N-benzoyl-L-tyrosyl-PABA (25.5 (3.6)) mumol/l for patients, 26.1 (2.0) mumol/l for controls). However, the mean (s.e.m.) PABA excretion index was significantly lower in the patients (0.58 (0.08)) than in the controls (0.76 (0.04)). Four patients required pancreatic enzyme supplements for control of diarrhoea. Self-limiting pancreatic leaks occurred in two patients. The results suggests that the sutureless pancreatico-enteric anastomosis has an acceptably low leakage rate but that pancreatic exocrine function is diminished following pancreaticoduodenectomy with this technique. However, the majority of patients require no enzyme supplements and no significant tendency to late stenosis of the anastomosis was demonstrated.

Evaluation of tests of exocrine and endocrine pancreatic function in older patients with cystic fibrosis.

In order to determine the value of noninvasive tests in the analysis of pancreatic function in cystic fibrosis, 14 older cystic fibrosis patients were studied by a set of noninvasive tests of exocrine and endocrine pancreatic function. The tests, comprising trypsin, total amylase, pancreatic isoamylase, lipase, pancreatic polypeptide (PP), glucose and insulin in fasting serum, PP, glucose and insulin in postprandial serum, and p-aminobenzoic acid (PABA) excretion in urine, were compared to fecal fat excretion after discontinuation of pancreatic enzyme supplementation. Eleven of the 14 patients were found to have a fecal fat excretion of more than 7 g/day. Serum levels of trypsin, pancreatic isoamylase and lipase, and the urinary excretion of PABA showed significant negative correlations with fecal fat excretion. Endocrine pancreatic function was abnormal in the majority of patients with fibrocystic disease. Although serum trypsin, postprandial PP, and urinary PABA excretion were the most sensitive tests for severe exocrine pancreatic insufficiency, the differences in sensitivity were rather modest. Therefore, the type of test to be selected for clinical use is mainly dependent upon factors as accessibility, simplicity, patient's acceptability, and costs.

The development of the chymotryptic activity during postnatal life using the bentiromide test.

The chymotryptic activity was assessed in 40 newborns and infants age 3-180 days using the NBT-PABA test. Nine newborns were studied serially at different age periods. A group of 18 cystic fibrosis patients and a group of 17 healthy children served as pancreatic insufficient and pancreatic sufficient controls, respectively. The results demonstrate a gradual increase with age of chymotryptic activity, approaching the levels of older children at about 180 days. The newborns who were studied serially demonstrated an individual pattern of increase in their chymotryptic activity. In the first days of life, newborns show low chymotryptic activity similar to that found in cystic fibrosis patients.

Reversibility of exocrine pancreatic failure in chronic pancreatitis.

In patients with chronic pancreatitis, the development of exocrine pancreatic failure is generally thought to be an irreversible process. We found evidence to the contrary in a prospective study of 70 patients who were evaluated by endoscopic retrograde cholangiopancreatography and sequential measurements of stool fat, percent urinary PABA excretion, and serum trypsin during a follow-up time period of 1-4 yr. Initial p-aminobenzoic acid (PABA) testing showed exocrine failure in 51 patients, 35 of whom had low serum trypsin levels while 14 (27%) disclosed unexpectedly high trypsin concentrations. Ductal morphology was similar in patients with low and high trypsin values. In 8 of the latter cases, steatorrhea improved and pancreatic function tests became normal after pancreaticojejunostomy in 4 patients, alcohol abstinence in 3 patients, and spontaneous resolution of a pseudocyst in 1 patient. Pancreatic cancer was present in a further 3 patients. Of the 37 patients with low PABA and low trypsin at the outset, there was no improvement of exocrine function in 17 of 18 who were surgically treated. Conservative treatment had a similar effect in another 6 patients who were available for follow-up in this group. The mean duration of symptomatic disease was shorter (p less than 0.001) in patients with low PABA and high trypsin levels (1.4 +/- 1.2 yr) than in those with low PABA and low trypsin levels (4.5 +/- 1.3 yr). The results show that up to 20% of patients with chronic pancreatitis have exocrine pancreatic failure, which is apparently due to early ductal obstruction of a gland with preserved function; this situation can be suspected when low urinary PABA excretion and high serum trypsin levels are simultaneously found; and (c) exocrine failure may be reversible in these patients by using a pancreatic drainage procedure or alcohol abstinence. Such a peculiar pattern of pancreatic function tests may also suggest pancreatic cancer.

Comparison of the oral (PABA) pancreatic function test, the secretin-pancreozymin test and endoscopic retrograde pancreatography in chronic alcohol induced pancreatitis.

The oral (PABA) pancreatic function test (PFT), the secretin-pancreozymin test and endoscopic retrograde pancreatography (ERCP) have been carried out in 32 patients with suspected chronic alcohol induced pancreatitis (CAIP) in order to evaluate which, if any, test was most likely to confirm the provisional diagnosis. Thirty one patients had changes of minimal (n = 6) moderate (n = 7) or advanced (n = 18) chronic pancreatitis on pancreatography, whilst one patient had a pancreas divisum. Eight hour urinary PABA excretion was significantly reduced in patients with moderate and advanced structural changes (p less than 0.001) and correlated significantly with all parameters of the PFT, although eight patients with an abnormal pancreatogram and pancreatic function test had a normal PABA value. The PFT was abnormal in 23 patients, but normal in five patients with an abnormal pancreatogram and low PABA value. Most patients with minimal change pancreatitis had a normal PABA test and PFT. We conclude that pancreatography appears to be the most sensitive method for detecting chronic pancreatic damage and for confirming a clinical diagnosis of chronic alcohol induced pancreatitis. Both the PFT and PABA test are useful confirmatory tests and whilst the PFT is slightly more sensitive for assessing pancreatic exocrine function, the PABA test is well tolerated and simple to perform. It may therefore be the complementary investigation of choice for this group of patients.