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At least 73 records · Page 4Linked to original sources

PubMed2000

Long-term results after endoscopic pancreatic stent placement without pancreatic papillotomy in acute recurrent pancreatitis due to pancreas divisum.

BACKGROUND: There is no consensus regarding the appropriate endoscopic treatment for acute recurrent pancreatitis associated with pancreas divisum. Endoscopic papillotomy of the minor papilla appears to yield improvement in most cases, but optimal depth and height have not been defined. METHODS: Endoscopic pancreatic stent placement after minor papilla dilation was performed in 25 patients with pancreas divisum and acute recurrent pancreatitis. Five patients drank alcohol daily; no other cause of pancreatitis was detected. After adequate dilation, a transpapillary pancreatic stent (5F to 7F, 5 to 7 cm) was inserted over a guidewire into the dorsal duct. The stent was replaced twice, after 2- to 3-month intervals. RESULTS: While stents were in place, no further episodes of pancreatitis occurred in 23 patients. However, dorsal duct changes of unknown clinical significance were seen in 21 cases. At mean follow-up of 24 months (range 3 to 70 months) after stent removal, 19 (76%) remained symptom free. Pancreatitis recurred in 6 patients during the follow-up after final stent removal; no further pancreatitis occurred in 2 of 3 who underwent repeat stent insertion. Complications in the series were minimal. CONCLUSION: Endoscopic pancreatic stent placement after minor papilla and dorsal duct dilation, without endoscopic papillotomy, provided safe and effective endoscopic treatment in patients with pancreas divisum and acute recurrent pancreatitis.

Acute Disease↗

PubMed1991

The effect of pancreatic polypeptide and peptide YY on pancreatic blood flow and pancreatic exocrine secretion in the anesthetized dog.

Pancreatic polypeptide (PP) and peptide YY (PYY) are inhibitors of pancreatic exocrine secretion in vivo but not in vitro, which suggests intermediate mechanisms of action. To examine the role of pancreatic blood flow in these inhibitory effects, xenon-133 gas clearance was used to measure pancreatic blood flow while simultaneously measuring pancreatic exocrine secretion. PP or PYY (400 pmol/kg/h) was administered during the intermediate hour of a 3-h secretin (125 ng/kg/h)/cholecystokinin octapeptide (CCK-8) (50 ng/kg/h) infusion. Exocrine secretion and pancreatic blood flow during the PP or PYY hours were compared with that observed in the first and third hours of the secretin/CCK-8 infusion. PP and PYY significantly inhibited secretin/CCK-8-induced pancreatic exocrine secretion. In addition, PYY (but not PP) significantly reduced pancreatic blood flow during secretin/CCK-8 stimulation. Nevertheless, there was no correlation between pancreatic blood flow and bicarbonate or protein outputs. It is concluded that changes in pancreatic blood flow do not mediate the inhibitory effects of PP or PYY on the exocrine pancreas.

Animals↗

PubMed1994

Effect of 5-fluorouracil on secretion and synthesis of pancreatic digestive enzymes: studies in isolated pancreatic acini and perfused pancreas derived from normal rats and from rats with acute necrotizing pancreatitis.

5-Fluorouracil (5-FU) has been claimed to have beneficial effects in human pancreatitis because of its ability to inhibit protein synthesis and secretion. However, the effect of 5-FU has not been studied in the pancreas of animals in more detail and the data in human pancreatitis are mostly derived from uncontrolled studies. Thus, we studied potential short-term effects of 5-FU on protein synthesis and secretion in isolated pancreatic acini from normal rats and from rats with sodium taurocholate-induced pancreatitis. Furthermore, we used the isolated perfused pancreas, damaged by taurocholate, to study whether arterial perfusion with 5-FU has any beneficial effects. When pancreatic acini were incubated with various concentrations of 5-FU, CCK-8-stimulated amylase secretion was not altered. Furthermore, 5-FU had no short-term effects on protein synthesis. Protein synthesis and secretion was already markedly depressed in isolated pancreatic acini derived from rats with sodium taurocholate-induced pancreatitis. 5-FU did not further decrease protein synthesis or secretion. Retrograde injection of sodium taurocholate in the main pancreatic duct of the isolated perfused pancreas resulted in a steep increase of amylase and lipase in the portal effluate. Arterial perfusion with 5-FU had no influence on enzyme release into the portal blood. We may conclude that our data, derived from experimental pancreatitis in rats, do not encourage investigation of the effect of 5-FU, an anticancer drug with possibly toxic side effects, in human pancreatitis.

Acute Disease↗

PubMed2003

Severe localized stenosis and marked dilatation of the main pancreatic duct are indicators of pancreatic cancer instead of chronic pancreatitis on endoscopic retrograde balloon pancreatography.

BACKGROUND: Differentiation between benign and malignant localized stenoses of the main pancreatic duct is difficult by pancreatography. METHODS: A total of 48 patients with such localized stenosis who underwent endoscopic retrograde balloon pancreatography with abdominal compression were retrospectively studied. The following were examined: (1) diameter of the stenotic, prestenotic, and poststenotic ductal segments; (2) ratios of prestenotic/poststenotic, stenotic/prestenotic, and stenotic/poststenotic ductal segments; (3) length of stenosis and steepness of transition to the stenosis (proximal angle, distal angle); and (4) main duct and branch findings for peristenotic segments. RESULTS: The stenosis was diagnosed as caused by chronic pancreatitis in 27 patients and pancreatic cancer in 21 by histopathology, cytology, or clinical follow-up. The prestenotic/poststenotic ductal segments ratio and proximal angle were greater in pancreatic cancer compared with chronic pancreatitis. Severe stenosis (stenotic ductal segments less than 20% of prestenotic or poststenotic ductal segments); moderate (prestenotic ductal segments 2.5 to 3.5 times larger than poststenotic ductal segments), and severe (prestenotic ductal segments more than 3.5 times larger than poststenotic ductal segments) dilatation of the proximal duct were more frequent in pancreatic cancer than in chronic pancreatitis. Multivariate regression analyses showed that severe stenosis and dilatation were independently significant parameters that indicated a diagnosis of pancreatic cancer. Various combinations of severe stenosis, proximal dilatation, and double duct sign gave high predictive values. CONCLUSIONS: Severe stenosis, marked proximal dilatation, double duct sign, and combinations of these findings are useful indicators of malignant localized stenosis of the pancreatic duct.

Adult↗

PubMed2002

Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis.

OBJECTIVE: To review the current status of pancreatoduodenectomy for pancreatic cancer and chronic pancreatitis using evidence-based methodology. SUMMARY BACKGROUND DATA: Despite improved results of pancreatoduodenectomy over the recent years, the reputation of the Whipple procedure and its main modifications has remained poor. In addition, the current status of newer modifications of standard pancreatoduodenectomy is still under debate. METHODS: Medline search and manual cross-referencing were performed to identify all relevant articles for classification and analysis according to their quality of evidence. The search was limited to articles published between 1990 and 2001. RESULTS: The mortality rate of pancreatoduodenectomy has declined to less than 5% for chronic pancreatitis and 3% to 8% for pancreatic cancer. In contrast, overall morbidity rates remain high, ranging between 20% and 70%. Delayed gastric emptying represents almost half of all complications. The overall 5-year survival rate for patients with pancreatic cancer remains poor, ranging between 5% and 15%, with a median survival of 13 to 17 months. Mortality and morbidity are not related to the type of pancreatoduodenectomy; however, patients with pancreatic cancer tend to be at increased risk for complications. Extended lymph node dissection and portal vein resection can be performed with similar mortality and morbidity rates as standard procedures, but without apparent survival benefits in the long term. Major relief of pain is achieved in 70% to 100% of patients with chronic pancreatitis. CONCLUSIONS: Pancreatoduodenectomy and its main modifications are safe and effective treatment modalities, especially in experienced centers with a high patient volume. For chronic pancreatitis, surgical resection provides major relief of pain and thus increased quality of life. Overall survival for patients with pancreatic cancer is determined predominantly by the pathology within the resected specimen.

Adenocarcinoma↗

PubMed2004

Expression of cancer testis antigens in pancreatic carcinoma cell lines, pancreatic adenocarcinoma and chronic pancreatitis.

In order to define antigens that might be suitable as vaccines for pancreatic carcinoma, we investigated the composite expression of 10 cancer testis (CT) antigens (SCP-1, NY-ESO-1, SSX-1, SSX-2, SSX-4, GAGE, MAGE-3, MAGE-4, CT-7 and CT-8) by Reverse Transcriptase-PCR (RT-PCR) in fresh biopsies of human pancreatic adenocarcinoma, chronic pancreatitis and pancreatic carcinoma cell lines. While all CT genes were frequently expressed in cell lines derived from pancreatic cancer, no expression of MAGE-3, SSX-1, SSX-2, NY-ESO-1 and CT-7 was detected in fresh tumor biopsies, and MAGE-4 (1/52), SSX-4 (1/39) and CT-8 (2/41) were only rarely expressed. In contrast, HOM-TES-14/SCP-1 was expressed in 48% (29/61) and GAGE in 21% (13/61) of cases, respectively. One CT gene was expressed by 59% (75% in male, 46% in female patients; p = 0.05) and 2 or more CT genes by 15% of the samples. SCP-1 protein expression correlated well with mRNA expression. While SCP-1 and GAGE were absent in normal pancreas, they were found in 2/8 (SCP-1) and 1/8 (GAGE) samples of chronic pancreatitis, respectively, supporting the concept of chronic pancreatitis as a premalignant condition. SCP-1 and GAGE represent promising candidates for vaccine development in pancreatic carcinoma. Whether SCP-1 and GAGE expression identify cases of chronic pancreatitis with a high risk of malignant transformation remains to be shown.

Acetaminophen↗

PubMed1994

Pancreatic lesions and modifications of pancreatic juice in tropical chronic pancreatitis (tropical calcific diabetes).

Seventeen Indian patients from Kerala State and 13 Indian controls were submitted to a dietary inquiry. Indian patients and controls had a low fat intake (40.8 g +/- 12.1 and 34.5 g +/- 11.0 per day, respectively) and a moderately low protein intake (52.8 +/- 9.5 and 47.8 +/- 11.3 g per day); 11 patients and 6 controls did not consume cassava. Pure nonactivated pancreatic juice was collected at endoscopy in 10 Indian patients who presented with tropical calcific diabetes, 12 apparently normal controls from the same area, and 23 apparently normal French controls. The only significant differences between Indian and French controls was a decreased pancreatic protein response to cerulein and an increased calcium concentration in the Indian subjects. The pancreatic juice of Indian patients was characterized by decreased volume, normal bicarbonate concentration, increased protein concentration when the acinar cells were not stimulated, with no response to cerulein, increased calcium concentration, and normal citrate concentration. These changes are very similar to the changes observed in French patients with chronic alcoholic pancreatitis. The lesions of 14 surgical resection pancreatic specimens from South Indian patients presenting with tropical pancreatitis were compared to pancreata from French patients presenting with chronic alcoholic pancreatitis. The only difference was that intraductal plugs, lesions of the duct epithelium, and retention cysts or pseudocysts were less frequent in Indians. These results show that the two nutritional forms of pancreatic lithiasis, alcoholic and tropical, have similar histological lesions and biochemical modifications of pancreatic juice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Pancreatic and bile duct obstruction exacerbates rat caerulein-induced pancreatitis: a new experimental model of acute hemorrhagic pancreatitis.

BACKGROUND: Pancreatic duct obstruction induces edematous but not hemorrhagic pancreatitis even when combined with maximal secretory stimulation. The aim of the present study was to test the hypothesis that pancreatic and bile duct obstruction exacerbates edematous pancreatitis induced by supramaximal secretory stimulation by caerulein. METHODS: In in vivo studies using rats, biliopancreatic duct ligation was combined with supramaximal stimulation of caerulein, and pancreatic histology, serum amylase level, pancreatic edema, and intrapancreatic trypsin activation were evaluated. In in vitro studies, the pancreatic acini were isolated from the rats with biliopancreatic duct ligation, and amylase secretion, intracellular trypsin activation, and acinar cell fragility were evaluated. RESULTS: Biliopancreatic duct ligation exacerbated caerulein-induced pancreatitis from edematous to hemorrhagic only when the obstruction preceded caerulein administration. The amylase secretion from the acini was inhibited, and intracellular trypsin activation and the acinar cell fragility on the supramaximal stimulation with cholecystokinin in vitro were enhanced by the preceding in vivo biliopancreatic duct obstruction. CONCLUSIONS: Preceding biliopancreatic duct obstruction exacerbates caerulein-induced pancreatitis. Enhancement of intracellular trypsin activation is possibly involved in this mechanism.

Amylases↗

PubMed1985

Conservation of pancreatic tissue by combined gastric, biliary, and pancreatic duct drainage for pain from chronic pancreatitis.

In patients with chronic pancreatitis, the sclerosing process of the pancreas may constrict not only the pancreatic duct for also the bile duct and duodenum. This study analyzes the prevalence of these obstructive lesions in 58 consecutive patients with chronic pancreatitis requiring surgery for either pain (57 patients) or for painless jaundice (1 patient). There was significant biliary obstruction in 21, 4 of whom also had symptomatic duodenal obstruction. All 21 patients with biliary and duodenal obstruction were among the 38 with a dilated pancreatic duct suitable for pancreaticojejunostomy (modified Puestow procedure). None of the 20 patients with small duct pancreatitis had biliary or duodenal obstruction. Pseudocysts were distributed evenly between the two groups (9 of 38 patients with a dilated duct versus 4 of 20 patients with small duct pancreatitis). Pancreaticojejunostomy combined with choledochoenterostomy and gastrojejunostomy in appropriately selected patients provided good to excellent long-term (mean 3.6 years) relief of pain in 30 of 36 patients (83 percent). There was no correlation between successful relief of pain and development of pancreatic exocrine or endocrine insufficiency or calcification. Stenosis of the bile duct developed some years subsequent to pancreaticojejunostomy in four patients and required a second operation for choledochoenterostomy in three. Three other patients required secondary pancreatic resections due to failure of the pancreaticojejunostomy to relieve pain. It is often possible to effect excellent relief of symptoms with maximal conservation of remaining pancreatic functions despite sclerotic obstruction of multiple organ systems.

Adolescent↗

PubMed1995

Quantitative analysis of collagen and collagen subtypes I, III, and V in human pancreatic cancer, tumor-associated chronic pancreatitis, and alcoholic chronic pancreatitis.

The collagen content in human pancreatic cancer tissue, tissue of tumor-associated chronic pancreatitis (TACP), and normal pancreatic tissue was determined in 14 patients with pancreatic cancer by measuring the amount of 4-hydroxyproline. Four patients with alcoholic chronic pancreatitis (AlCP) were also analyzed. The mean collagen content in both pancreatic cancer tissue and TACP tissue was approximately threefold higher than in normal pancreatic tissue. Cyanogen bromide peptides of type I, III, and V collagens from invasive ductal carcinomatous tissue of the pancreas and from TACP tissue of eight patients were analyzed sequentially using high-performance liquid chromatography with ion-exchange and gel-permeation columns. No difference in the proportion of type I, III, and V collagens was detected between pancreatic cancer tissue and TACP tissue. The mean collagen content in AlCP tissue was significantly lower than that in TACP tissue, but no difference in the proportion of type I, III, and V collagens was detected between these two tissues. These results indicate a similar quantity and distribution pattern of fibrillar collagen in human pancreatic cancer and TACP.

Alcoholism↗

PubMed2006

[A case of the pancreatic duct change after a long-term pancreatic stenting in pancreas divisum and the fine structural analysis of occluded pancreatic polyethylene stent].

The pancreatic duct stenting is now recognized as the treatment option for a number of pancreatic disorders. Although the stent-induced ductal changes may result, there is little information regarding the frequency of these stent-induced changes in chronic pancreatitis. Pancreatic stents may occlude with time, but there is only little information available on the nature of the clogging process. Although a short-term efficacy of endoscopic pancreatic duct stenting has been proved, the long-term efficacy continues to be controversial. The aim of this study was to report a case of chronic pancreatitis with pancreatolith after the incidental long-term pancreatic stenting for 3 years due to a pancreas divisum with acute pancreatitis. Also, this study described the analysis of the ultrastructural changes in the surface of an occluded pancreatic stent. A scanning and transmission electron microscopy showed an amorphous protein matrix in whole stent that arranged as a network in some areas but arranged as the layers in other areas. A variable number of bacteria of mixed species, calcium carbonate or calcium oxalate crystal, round leukocyte were scattered in the protein matrix. The yeast and plant material were seen in some part of the stent as well.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1985

[Changes in serum pancreatic enzymes and pancreatic secretory trypsin inhibitor in patients with severe acute pancreatitis].

Serum pancreatic enzymes (amylase, trypsin, pancreatic elastase 1, pancreatic phospholipase A2) and serum pancreatic secretory trypsin inhibitor (PSTI) were measured in 22 patients with moderate or severe acute pancreatitis. Serum levels of all pancreatic enzymes were elevated at the initial determination, but they fell rapidly to normal in both moderate and severe pancreatitis. In contrast, PSTI in severe pancreatitis increased after admission and reached the maximum on the second to the forth day after onset. There was a significant positive correlation between the level of PSTI and that of acute phase reactant (fibrinogen, alpha 1-antitrypsin), and serum PSTI in severe acute pancreatitis changed as if it was one of acute phase reactants. There was also a significant negative correlation between the level of serum PSTI and that of alpha 2-macroglobulin.

Acute Disease↗

PubMed1984

Serum immunoreactive trypsin, pancreatic polypeptide, and pancreatic isoamylase as diagnostic tests for chronic pancreatitis.

The efficiency of immunoreactive trypsin (IRT), pancreatic polypeptide (PP), and pancreatic isoamylase (PI) in the diagnosis of chronic pancreatitis was studied in 80 consecutive patients clinically suspected of having chronic pancreatitis. Twenty-five patients had chronic pancreatitis, and of these, 17 had pancreatic insufficiency. IRT, PP, and PI were of no value in the diagnosis of chronic pancreatitis without insufficiency. The three tests were of equal but limited value in diagnosing pancreatic insufficiency (nosographic sensitivities, 0.53 to 0.59, and predictive values of a negative test, 0.88 to 0.90). The combination of IRT, PP, and PI did not increase the diagnostic efficiency compared with each of the three tests alone. We conclude that IRT, PP, and PI are of similar but limited value as diagnostic tests for pancreatic insufficiency.

Adult↗

PubMed1984

[Evaluation of pancreatic ductal decompression procedure for patients with advanced chronic pancreatitis, mainly from the viewpoint of pancreatic ductal changes].

Several pancreatic ductal decompression procedures have been applied for chronic pancreatitis. Unresolved problems, however, remain, i.e., to select the appropriate procedure among several different decompression procedures, to investigate the changes of pancreatic endocrine and exocrine functions resulting from such procedures, etc. In this paper we evaluated these problems, mainly by comparing conditions of the pancreatic duct as seen with pre- and post-operative endoscopic retrograde pancreatography (ERP). We classified the pancreatic duct of patients with chronic pancreatitis into seven types. This classification was devised so that the selection of the suitable operative procedure could be made. The severity of the abnormal ductal change was also evaluated. Eighteen patients were studied with reference to the post-operative change in the pancreatic duct and the patency of the pancreaticoenteral anastomosis in each procedure. Postoperative ERP showed good patency in the patients with lateral pancreaticojejunostomy and modified bilateral pancreaticojejunostomy, both having long anastomotic stoma. Among the findings of postoperative pancreatic ductal changes, the dilatation of the main duct was reduced in most of the patients, while the stenosis of the main duct remained unchanged in nearly all the patients. The duct in the tail area showed the best results, which suggested the importance of preservation of the pancreatic tail.

Adult↗

PubMed1986

Evaluation and comparison of cathodic trypsin-like immunoreactivity, pancreatic lipase and pancreatic isoamylase in the diagnosis of acute pancreatitis in 849 consecutive patients with acute abdominal pain.

In 849 patients (417 men, 432 women) consecutively hospitalized with acute abdominal pain we compared the value of serum cathodic trypsin-like immunoreactivity, pancreatic lipase (EC 3.2.1.3) and pancreatic isoamylase (EC 3.2.1.1) as diagnostic tests for acute pancreatitis. The diagnoses of acute pancreatitis (in 49 patients, 5.8%) and other diseases were made without knowledge of these enzyme values. When evaluated by means of receiver operating characteristic curves no differences were found in diagnostic performance of the three enzymes. Use of combinations of different enzymes had no advantage over single enzyme determination using discrimination analysis for evaluation. The highest efficiency was for all three enzymes 0.991 (95% confidence limits: 0.983-0.995) and for all three enzymes the discrimination value giving this efficiency was several times the upper limit of reference range: 1 779 micrograms/l for cathodic trypsin-like immunoreactivity, 831 U/l for pancreatic isoamylase and 316 micrograms/l for pancreatic lipase. None of the enzymes had any prognostic value at admission in predicting a mild or severe attack of acute pancreatitis. In conclusion, no single enzyme or combination of enzymes had any diagnostic advantage for acute pancreatitis in patients with acute abdominal pain. Thus selection of one of the three enzymes as diagnostic test of acute pancreatitis is to be based on considerations such as economy, methodological simplicity, possibility of automated assay and the time-consumption at the assay.

Abdomen↗

PubMed1996

Improvement of pancreatic capillary blood flow does not augment the pancreatic tissue concentration of imipenem in acute experimental pancreatitis.

BACKGROUND: Acute necrotizing pancreatitis (ANP) is characterized by decreased capillary pancreatic blood flow. Thus, antibiotics may not reach pancreatic necrosis in therapeutic concentrations and consequently fail to prevent bacterial infection of the pancreas which today is the major cause of morbidity and mortality in ANP. OBJECTIVE: To evaluate whether improvement of impaired pancreatic microcirculation by isovolemic hemodilution with dextran leads to an increase in the pancreatic tissue concentration of imipenem (IMI), an antibiotic widely used in clinical ANP. METHOD: After induction of ANP rats were randomized for either standard fluid therapy with Ringer's lactate (RL) or isovolemic hemodilution with dextran 70,000 (IHD/DEX). Thereafter the animals received an intravenous injection of IMI, and 15 min later they were sacrificed for determination of IMI in serum and tissue. Capillary pancreatic blood flow (CPBF) at the time of antibiotic therapy was assessed by intravital microscopy in an additional set of animals. RESULTS: There was no significant difference in the pancreatic tissue concentration of IMI in animals pretreated with either RL (11.7 +/- 0.6 micrograms/g) or IHD/DEX (11.4 +/- 1.4 micrograms/g), although CPBF was significantly increased in the latter group (1.3 +/- 0.05 vs. 0.8 +/- 0.04 nl/min/capillary). CONCLUSION: (1) IMI is concentrated by the pancreas in experimental ANP despite impaired CPBF. (2) Enhancement of pancreatic capillary blood flow by IHD/DEX does not increase the pancreatic tissue concentration of IMI. This suggests that CPBF is not a decisive factor influencing the accumulation of this antibiotic in the pancreas, which may be one reason for the high efficacy of IMI in clinical ANP.

Acute Disease↗

PubMed1983

[Purification and development of immunoassay of pancreatic enzymes and trypsin inhibitor, and their application to elucidation of pathogenesis of various pancreatic and pancreatic enzyme-producing diseases].

Pancreatic amylase, elastase 1, elastase 2, cationic trypsin, chymotrypsin, ribonuclease (RNase), phospholipase A2, gamma-glutamyl transpeptidase (gamma-GTP) and pancreatic secretory trypsin inhibitor (PSTI) were purified and characterized from human pancreatic juice and pancreatic tissue. During the purification of these enzymes, two enzymes previously not reported were found. A pancreatic deamidase and a renal endopeptidase were purified and characterized. Specific and reliable radioimmunoassays (RIAs) were developed for all pancreatic enzymes and inhibitor. The purpose of immunoassay for pancreatic enzymes and inhibitor was discussed, and clinical application for the diagnosis of pancreatic diseases was demonstrated. Messenger RNA (mRNA) of amylase was isolated from human pancreas and parotid gland, and used to prepare a complementary DNA (cDNA). The nucleotide sequence and the predicted amino acid sequence of these clones were now being determined. The application of the present investigation to elucidation of pathogenesis of pancreatic enzyme-producing diseases was discussed.

Amylases↗

PubMed1988

Use of pancreatic Schilling test to determine efficiency of pancreatic enzyme delivery in pancreatic insufficiency.

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.

Adult↗