Assessment of pancreatic enzyme secretory capacity by a modified Lundh test.

BACKGROUND: The Lundh test is a usual means of estimating the enzyme secretory capacity of the gland. During this procedure, however, a major proportion of the test meal is removed from the duodenum together with the gastric, duodenal, and pancreatic secretions and the bile. This study was undertaken to compare the pancreatic enzyme secretion induced by the Lundh procedure with that resulting from stimulation of the normal digestive process, by reinfusion of the aspirated duodenal juice. METHODS: Nine men (mean age: 46.7, range 42-55 yr) free from pancreatic disease were studied. Pancreatic secretion was measured via a multiple lumen tube by aspiration of the duodenal juice. After a basal period the Lundh test meal was placed in the stomach and the duodenal juice was completely aspirated. On a separate day, the procedure was repeated, but the aspirated duodenal juice was reinfused into the upper jejunum. RESULTS: In the first 30 min of the test period, the enzyme outputs were the same on both test days. In the 30-60-min period, the lipase output, and in the 75-90-min period, the amylase output was significantly lower during the Lundh test compared with the jejunal reinfusion test. The CCK levels were significantly above the basal level at 20 and 40 min, but the increase was significantly lower during the traditional Lundh test. No significant difference in gastrin release was observed during either the Lundh or the reinfusion test. CONCLUSIONS: In the traditional Lundh test, the trypsin secretory capacities of the gland are measured appropriately, but the lipase and amylase secretory capacity and the CCK release are not fully represented compared with the reinfusion test. An association between the lower CCK release and lipase amylase secretion is suggested.

New methods for assessment of enzyme activity: do they help to optimize enzyme treatment?

Several factors related to the patient and the pancreatin formulation influence the efficacy of enzyme supplementation. Up to now, only few tests exist to judge the efficacy of enzyme replacement therapy in pancreatic insufficiency. Tube tests and fecal fat excretion studies are cumbersome, time-consuming and unpleasant. Recently, several breath tests for the detection of pancreatic insufficiency have been developed. The cholesteryl octanoate breath test differentiated between healthy controls and patients with pancreatic insufficiency already after a 30-min collection period. Using this test, it was demonstrated that a pancreatin preparation containing small microspheres (1.0-1.2 mm) induces high duodenal lipolytic activity parallel to gastric emptying of food. In contrast, the gastric emptying of large microspheres (1.8-2.0 mm) is significantly delayed. The cholesteryl octanoate breath test detects pancreatic insufficiency within 30-60 min and offers the possibility of monitoring the in vivo release of pancreatin preparations.

[Assessment of the in vitro digestibility of dietary proteins and of the degree of the breakdown of their antigenic structures by using polyenzyme systems]. / Otsenka perevarivaemosti in vitro pishchevykh belkov i stepeni rasshchepleniia ikh antigennykh struktur s ispol'zovaniem polifermentnykh sistem.

A comparative assessment was made of the digestion of bovine serum albumin (BSA), chicken ovalbumin (OVA), and casein by means of the gastric juice--duodenal contents floccular gel structures (FGS) system and a four-enzymic system including trypsin, chymotrypsin, peptidase, and bacterial protease preparations. Decomposition of the BSA and OVA antigenic structures with the use of the two systems was also studied. Significant differences in BSA and OVA digestion by the gastric juice--FGS system were detected both with respect to amino nitrogen content and to the degree of their antigenic structure decomposition, whereas no such differences were observed when the four-enzymic system was used. The systems most accurately simulating the 'proteolytic conveyer' conditions of the gastrointestinal tract are preferable for the studies. The developed method is recommended for use in comparative assessment of the nutrient protein sensitizing properties.