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- A Multicenter Open-Label Randomized Controlled Trial of Pancreatic Enzyme Replacement Therapy in Unresectable Pancreatic Cancer. [Randomized Controlled Trial]
- PPancreas 2018; 47(7):800-806
- CONCLUSIONS: In this randomized controlled trial, pancrelipase failed to improve the change in BMI at 8 weeks in PC patients receiving chemotherapy.
- Modified Xiaochaihu Decoction () prevents the progression of chronic pancreatitis in rats possibly by inhibiting transforming growth factor-β1/Sma- and mad-related proteins signaling pathway. [Journal Article]
- CJChin J Integr Med 2013; 19(12):935-9
- CONCLUSIONS: MXD could protect the pancreas against chronic injury and improve pancreatic exocrine function in DBTC induced rat CP model. Its mechanism may involve inhibition of the TGF-β1/Smads signaling pathway.
- Diagnosis of chronic pancreatitis: Functional testing. [Review]
- BPBest Pract Res Clin Gastroenterol 2010; 24(3):233-41
- The diagnosis of chronic pancreatitis is mainly based on imaging procedures (e.g., endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI)). Fun…
The diagnosis of chronic pancreatitis is mainly based on imaging procedures (e.g., endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI)). Functional testing in this context could however be still of help in cases of inconclusive morphological findings. With this aim, only the secretin-pancreozymin test and the endoscopic test are sensitive enough. The role of other function tests, such as the quantification of the coefficient of fat absorption (CFA) and the (13)C-mixed triglyceride breath test, is limited to the diagnosis of exocrine pancreatic insufficiency with maldigestion. Faecal elastase and chymotrypsin are still useful for detecting reduction of pancreatic secretion in patients with different pancreatic diseases and patients' compliance to enzyme replacement therapy, respectively. Other tests used in the past (e.g., Lundh test, N-benzoyl-tryosyl para-aminobenzoic acid (NBT-PABA) test, pancreolauryl test and amino acid consumption test) are neither available now nor useful for clinical practice. This article reviews the different pancreatic function tests commercially available and their role in clinical practice.
- NBT-PABA test to assess efficiency and kinetics of substituted proteolytic enzyme action in pancreatic duct ligated minipigs. [Journal Article]
- JAJ Anim Physiol Anim Nutr (Berl) 2008; 92(3):399-404
- The NBT-PABA test is an established method for diagnosis of pancreatic exocrine insufficiency. In the present study the NBT-PABA test was used to test and compare the efficacy of two multienzyme prep…
The NBT-PABA test is an established method for diagnosis of pancreatic exocrine insufficiency. In the present study the NBT-PABA test was used to test and compare the efficacy of two multienzyme preparations (product A and B) differing in galenic preparation in minipigs in which pancreatic exocrine insufficiency (PEI) was induced by pancreatic duct ligation. Without enzyme substitution no distinct increase in PABA was found in blood after oral administration of NBT-PABA. Administration of both enzyme preparations led to a clear dose dependent rise in PABA-concentrations in blood. Interestingly, the two preparations showed different time curves of serum PABA concentration, indicating differences in the kinetic of proteolytic enzyme action. It is concluded that the NBT-PABA test can be a very useful test for indirectly evaluating proteolytic enzyme efficacy in vivo, and also gives information about the kinetics of enzyme action, not only the end-result of enzyme action (like digestibility trials which were used traditionally). A single test is performed in a few hours and there is no need for fistulated animals.
- [The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis]. [Review]
- ZGZ Gastroenterol 2004; 42(10):1117-28
- CONCLUSIONS: None of the non-invasive pancreatic function tests is sensitive enough to diagnose reliably a slight to moderate exocrine pancreatic insufficiency.
- Gastric transit and pharmacodynamics of a two-millimeter enteric-coated pancreatin microsphere preparation in patients with chronic pancreatitis. [Journal Article]
- DDDig Dis Sci 1998; 43(1):203-13
- It has been suggested that enteric-coated pancreatin microsphere (ECPM) preparations with sphere sizes larger than 1.7 mm pass through the stomach at a slower rate than a meal and therefore may be le…
It has been suggested that enteric-coated pancreatin microsphere (ECPM) preparations with sphere sizes larger than 1.7 mm pass through the stomach at a slower rate than a meal and therefore may be less efficacious in restoring pancreatic enzyme activity than preparations with smaller sphere sizes. The aim of this study was to investigate the gastric transit profile of a 2-mm ECPM preparation in relation to that of a solid meal and to simultaneously measure enzyme activities in eight patients with pancreatic exocrine insufficiency due to chronic pancreatitis. Gastric transit was assessed by double-isotope scintigraphy. A pancake was labeled with 99mTc. A 2-mm ECPM preparation was labeled with 171Er. Intraluminal pancreatic enzyme activities were assessed during a 6-hr period with the cholesteryl-[14C]octanoate breath test (for carboxyl ester lipase activity) and the N-benzoyl-L-tyrosyl-p-aminobenzoic acid/p-aminosalicylic acid (NBT-PABA/PAS) test (for chymotrypsin activity). The ECPM preparation passed through the stomach more rapidly (median 24 min) than the pancake (median 52 min, P < 0.05). During ECPM therapy, mean cumulative 14CO2 outputs rose significantly from 30% to 70% (P < 0.05), but remained below outcomes in healthy volunteers. Mean cumulative plasma PABA concentrations rose significantly from 46% to 87% (P < 0.05) and were not significantly different from outcomes in healthy volunteers. In chronic pancreatitis, a 2-mm ECPM preparation does not pass through the stomach more slowly than a solid meal, but in fact faster. Digestion of ester lipids and proteins showed an improvement to subnormal and normal levels, respectively.
- Oral absorption tests: absorption site of each substrate. [Journal Article]
- NNutrition 1998; 14(1):7-10
- Three oral absorption tests have been used in patients with short bowel syndrome (SBS) to evaluate the absorption site of each substrate. In this study, three absorption tests were applied: the oral …
Three oral absorption tests have been used in patients with short bowel syndrome (SBS) to evaluate the absorption site of each substrate. In this study, three absorption tests were applied: the oral pancreatic function test using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (NBT-PABA), the D-xylose tolerance test, and the oral fat tolerance test. Examinations were performed in eight patients with either a duodenostomy or a jejunostomy located less than 60 cm from the ligament of Treitz, and in a patient with an end ileostomy. Forty-six healthy volunteers participated as controls for the oral fat tolerance test. PABA and D-xylose concentrations were measured in urine. The serum triacylglycerol concentration was determined at 0, 1, 2, and 3 h after ingestion. All eight patients with SBS demonstrated pathologic absorption on each test. We conclude that small bowel integrity is critical for evaluation of the NBT-PABA test. We also determined that the duodenum and proximal jejunum do not play an important role in the absorption of D-xylose and triacylglycerol. We could also evaluate limitations and advantages of the other kinds of oral absorption tests and nutrients through patients with SBS.
- Comparative effects of enteric-coated pancreatin microsphere therapy after conventional and pylorus-preserving pancreatoduodenectomy. [Journal Article]
- BJBr J Surg 1997; 84(7):952-6
- CONCLUSIONS: In cases of exocrine pancreatic insufficiency after Whipple's procedure, 2-mm ECPM treatment adequately restores pancreatic enzyme activity. Following PPPD, however, ECPM treatment is often ineffective because the microspheres are retained in the stomach. In these patients, use of conventional powdered pancreatin enzyme preparations may improve the efficacy of treatment.
- Determination of the exocrine pancreatic function with the NBT-PABA test using a novel dual isotope technique and gas chromatography-mass spectrometry. [Journal Article]
- SJScand J Clin Lab Invest 1997; 57(2):159-65
- We describe a tubeless test of exocrine pancreatic function based on a new dual isotope technique, using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (NBT-PABA) as a substrate for intestinal chymotrypsin …
We describe a tubeless test of exocrine pancreatic function based on a new dual isotope technique, using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (NBT-PABA) as a substrate for intestinal chymotrypsin activity and the stable isotope, 13C-PABA as marker. Gas chromatography-mass spectrometry (GC-MS) was used for the quantification of PABA and 13C-PABA in blood. The method involves hydrolysis, extractions, separation by HPLC, and methyl ester formation of the test substances before GC-MS analysis. The test is precise and shows good separation of healthy volunteers from patients with pancreatic insufficiency. The PABA/13C-PABA ratios in serum after 1.5 h were 2.64 +/- 0.14 (mean +/- SEM) in 10 healthy volunteers and 1.26 +/- 0.22 in 10 patients with exocrine pancreatic insufficiency. We present a sensitive and specific assay, which is free of analytical interference and radiation hazards and, additionally, it illuminates extrapancreatic pharmacokinetic conditions. This test can eliminate the need for duodenal intubation, which makes it very acceptable to the patients.
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- [Comparison of three indirect pancreatic function tests in severe chronic pancreatitis--personal observations]. [Journal Article]
- PAPol Arch Med Wewn 1995; 94(4):315-23
- The aim of the presented study was a comparative evaluation of the three indirect pancreatic function tests: pancreolauryl-test (PLT), NBT-PABA test and faecal chymotrypsin (CH) efficacy in detecting…
The aim of the presented study was a comparative evaluation of the three indirect pancreatic function tests: pancreolauryl-test (PLT), NBT-PABA test and faecal chymotrypsin (CH) efficacy in detecting pancreatic exocrine function impairment in advanced chronic pancreatitis (acp). 30 patients with severe chronic pancreatitis (marked structure changes in ultrasound and CT following Cambridge criteria) confirmed by abnormal secretin-cerulein test (SCT) and 10 healthy controls underwent PLT, NBT-PABA and CH tests. The degree of pancreatic function impairment in SCT was classified following Malfertheiner into 3 subgroups: 1-mild, 2-moderate and 3-severe. All the indirect pancreatic function test were performed using commercially available kits (Temmler-Werke for PLT, Hoffman-La Roche for NBT-PABA and Boehringer Mannheim for CH) according to manufacturer instructions. PLT revealed changes in 27 (0.9), NBT-PABA-in 25 (0.83) and CH-in 22 (0.73) patients with acp. On the other hand those test have shown normal pancreatic function: PLT-in 0.9, NBT-PABA-in 0.7 and CH-in 0.8 in control group. The sensitivity of those test was increased up to 0.94 (PLT and NBT-PABA) and up to 0.88 (CH) and in the subgroup of severely impaired pancreatic function test in SCT. The concomittant use of two indirect pancreatic function tests caused increase of sensitivity up to 0.93. Our results suggest that with PLT, NBT-PABA and CH impaired pancreatic function may be succesfully recognized in advanced chronic pancreatitis, in particular, when two of them are applied concomittantly.