Variations with age of immunoreactive serum trypsin: higher reference ranges in "healthy" elderly people

An overview of the diagnosis and management of nutrition in chronic pancreatitis

Chronic pancreatitis is characterized by long-standing inflammation of the pancreas, which results in fibrosis and the gradual loss of pancreatic function. The loss of islets and acinar cells results in diabetes and exocrine insufficiency, respectively. Exocrine insufficiency can result in maldigestion of fat, protein, and carbohydrate as well as vitamins and minerals. Patients may present with variable severity of disease, from mild to severe. The diagnosis of chronic pancreatitis can be challenging, especially in patients with early or mild disease who have few to no morphologic abnormalities on standard abdominal imaging studies. A number of imaging modalities and tests have evolved to aid in the diagnosis of chronic pancreatitis based on changes in structure or function. Clinicians typically focus on treating pain in chronic pancreatitis as opposed to exocrine insufficiency, despite the fact that maldigestion and malabsorption can result in nutrition deficiencies. The aims of this review are to describe the various modalities used to diagnose chronic pancreatitis, to illustrate the nutrition deficiencies associated with exocrine insufficiency, and to provide an overview of nutrition assessment and treatment in these patients.

Pancreatic and biliary disorders in the elderly

Structural and functional changes in the biliary tract and pancreas associated with advanced age are well documented in the literature and must be taken into account in evaluating patients with possible biliary and pancreatic disorders. The relationship between normal, age-related physiologic changes and various pancreatico-biliary diseases is not well defined. Elderly patients may present with severe biliary and pancreatic disease that may pose difficult management problems because of coexisting medical illnesses. Despite these challenges, all but the most frail elderly patients can benefit from appropriate medical, endoscopic, and surgical therapy.

Function tests in the diagnosis of chronic pancreatitis. Critical evaluation

Direct pancreatic function tests, such as the secretin-pancreozymin test and the Lundh test, are--by direct measurement of the contents of duodenal secretion following exogenous (hormonal) or endogenous (test meal) stimulation--the best way to assess exocrine pancreatic function. However, these tests are time-consuming, invasive, and expensive, and therefore their use is limited to specialized centers only. Several studies have shown that indirect pancreatic function tests are a practicable alternative to direct pancreatic function tests for diagnosing exocrine pancreatic insufficiency. They allow staging of the disease and thereby facilitate comparison of different studies. They are also useful in some cases for determining whether pancreatic enzyme replacement therapy is necessary or not. In contrast to morphological procedures, they involve neither side effects, risks for the patient, nor complications for patients, investigators, and laboratory staff alike. The procedures being standardized, the test results depend to a lesser extent on the experience of the investigator, and more on the selection of and the instructions to the patient, and to some extent, on the severity of the exocrine pancreatic insufficiency. Like all pancreatic function tests, the indirect tests do not give a clue to etiology nor help investigators to differentiate between pancreatic insufficiency owing to chronic pancreatitis and that owing to pancreatic cancer. The role of pancreatic function tests in diagnosing early chronic pancreatitis in comparison to morphological examinations remains to be established.

Trypsin/creatinine clearance ratio and serum immunoreactive trypsin in digestive and pancreatic diseases

The behavior of trypsin/creatinine clearance ratio (Ctr/Ccr) and serum immunoreactive trypsin (IRT) was evaluated in a total of 168 subjects with pancreatic cancer, chronic pancreatitis and non-pancreatic digestive diseases. Amylase/creatinine clearance ratio (Cam/Ccr) and serum amylase levels were also evaluated in order to establish their possible relationship with Ctr/Ccr and IRT values. Elevated Ctr/Ccr and IRT values were observed in several patients with pancreatic cancer and chronic pancreatitis. Abnormal IRT and Ctr/Ccr values were found in 28.2 and 4% of non-pancreatic digestive diseases, respectively. IRT and amylase serum levels showed consensual modifications, while Ctr/Ccr showed a behavior different from that of Cam/Ccr. Liver damage seems to play a role in increasing serum IRT levels of patients without pancreatic involvement, while the increased Ctr/Ccr seems to depend on other factors, for instance renal tubular dysfunction.