alpha-chymotrypsin and bentiromide

Topics: 4-Aminobenzoic Acid; Amylases; Bicarbonates; Chymotrypsin; Feces; Fluoresceins; Humans; Isoamylase; Pancreatic Diseases; Pancreatic Function Tests; para-Aminobenzoates; Saliva; Trypsin

The diagnosis of chronic pancreatitis usually is based on imaging studies, pancreatic function tests, and the presence of characteristic clinical features. In Japan, diagnostic criteria for chronic pancreatitis were established in 1983 and revised in 1995. Under the new criteria, the secretin test (a duodenal intubation test) and the combination of noninvasive tests, N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) and fecal chymotrypsin (FCT), have been recommended for evaluating exocrine pancreatic function in patients with chronic pancreatitis. In the present study, the diagnostic value of these two noninvasive tests was compared to the secretin test. Although noninvasive tests are less sensitive and specific for determining exocrine pancreatic impairment than the secretin test, greater reliability for diagnosing chronic pancreatitis can be obtained by performing the BT-PABA and fecal chymotrypsin tests simultaneously. Combining BT-PABA and FCT is easy and useful and should be performed at least twice to obtain reliable results.

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Duodenum; Feces; Female; Humans; Intubation, Gastrointestinal; Male; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Secretin; Sensitivity and Specificity

To evaluate the effectiveness of exocrine function tests in diagnosing chronic pancreatitis (CP), we compared the sensitivity and specificity of duodenal intubation with tubeless tests. While the secretin test (ST) was necessary to diagnose CP, especially in noncalcified CP, and tubeless tests demonstrated insufficient sensitivity to diagnose CP, the combination assay of tubeless tests was specific enough to diagnose severe exocrine dysfunction. Our studies found the sensitivity of secretin testing to diagnose definite CP to be 87%. In patients with probable CP, 60% had mild exocrine insufficiency and 40% had normal function. The false-positive rate of the ST results in nonpancreatic diseases, except diabetes mellitus, was 5%. The correlation between morphological changes in endoscopic retrograde pancreatography (ERP) and exocrine function evaluated by ST was 74%. In patients with calcified CP, 81% had parallel results between ERP and the ST, but in noncalcified CP, 47% had parallel results. In patients with severe or moderate exocrine insufficiency demonstrated by ST, abnormally low levels were observed in 63% by N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) test, 61% by fecal chymotrypsin test (FCT), and 44% by pancreatic amylase (PA). In patients with normal exocrine function demonstrated by ST, abnormally low levels were observed in 28% by BT-PABA test, 28% by FCT, and 10% by PA. A combination assay of BT-PABA test, FCT, and PA improved the specificity for diagnosing CP but not the sensitivity.

Topics: 4-Aminobenzoic Acid; Amylases; Cholangiopancreatography, Endoscopic Retrograde; Chronic Disease; Chymotrypsin; Feces; Humans; Isoamylase; Pancreas; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Phospholipases A; Secretin; Sensitivity and Specificity; Severity of Illness Index; Tomography, X-Ray Computed; Trypsin; Ultrasonography

The clinical diagnosis of chronic pancreatitis is usually based on imaging studies, pancreatic function tests, and the presence of characteristic clinical features. In Japan, diagnostic criteria for chronic pancreatitis were established in 1995. The secretin test (a duodenal intubation test) and the combination of noninvasive tests, N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) and fecal chymotrypsin (FCT), have been recommended for evaluating exocrine pancreatic function in patients with chronic pancreatitis. In the present study, the diagnostic value of these two noninvasive tests was compared to the secretin test. Although noninvasive tests are less sensitive and specific for determining exocrine pancreatic dysfunction than the secretin test, greater reliability for diagnosing chronic pancreatitis can be obtained by performing the BT-PABA and FCT simultaneously. Assessment of exocrine pancreatic function is important not only to diagnose chronic pancreatitis but also to decide a treatment method with pancreatic enzyme preparation.

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Diagnosis, Differential; Feces; Humans; Pancreas; Pancreatitis; para-Aminobenzoates; Secretin

The steady increase in chronic pancreatitis among black Africans at Soweto, RSA, in the past 40 years necessitates an objective and non-invasive test to detect the disease at an early stage. Given the biphasic nature of the disease--secretory hyperfunction with periodic active inflammatory episodes followed by steady exocrine impairment--we assessed three potential aids. Urinary BT-PABA/PAS excretion index (PEI), serum pancreatic isoamylase (PIA) and faecal chymotrypsin activity (FCA) were measured in the following groups: 16 outwardly healthy hospital workers, 16 consecutive patients with calcifying chronic pancreatitis and 19 with abdominal pain ascribed to other conditions (disease controls). (1) Healthy controls had lower PEI than those at Manchester, UK, or Madras, India, from subclinical acinar loss--as shown by lower PABA recovery whereas intestinal absorptive capacity was maintained, as shown by recovery of PAS. (2) Using the popular cut-off for PEI (0.75) only 9 of 14 patients with chronic pancreatitis were identified (sensitivity 64%, 2 tests unsatisfactory), while a value of less than 0.54, the mean -2 S.D. in local controls, yielded sensitivity of 50%. (3) If PEI of less than 0.75 or PIA outside the reference range was taken to indicate the disease, 5 of 9 disease controls would have been classed as chronic pancreatitis (among those with both tests satisfactory): retrospective ultrasound scans did not identify these. (4) Although FCA was less than the preselected cut-off, 5 units/g, in every patient with chronic pancreatitis (100% sensitivity) its poor predictive value was indicated by low specificity: subnormal levels in 4 of 14 and 6 of 16 healthy controls or disease controls, respectively, most of whom had near-normal values of PEI, PIA or both. (5) Collectively, these results suggest a high frequency of subclinical chronic pancreatitis at Soweto, but also that the combination of tests required to identify it may prove impractical--whether in field surveys or hospital practice.

Topics: 4-Aminobenzoic Acid; Adult; Aminosalicylic Acid; Biomarkers; Black People; Chronic Disease; Chymotrypsin; Feces; Female; Humans; Isoamylase; Liver Function Tests; Male; Middle Aged; Pancreatitis; para-Aminobenzoates; Reference Values; South Africa; Urban Population

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.

Topics: 4-Aminobenzoic Acid; Adult; Aged; Chronic Disease; Chymotrypsin; Feces; Female; Fluoresceins; Humans; Indicators and Reagents; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Sensitivity and Specificity; Tomography, X-Ray Computed

To assess exocrine pancreatic function in patients before and after pancreatoduodenectomy (PD), we used the breath test, with nonradioactive 13C-labeled trioctanoin, in 14 patients before pancreatic resection because of localized pancreatic mass (preop-PD group), and in 13 patients who had undergone pancreatoduodenectomy more than 5 yr before (post-PD group). The results were compared with those of the secretin test, N-benzolyl-L-tyrosyl-p-amino benzoic acid (BT-PABA) test, and fecal chymotrypsin. Means +/- SD and frequencies of low values of the recovery of the breath test were 42.0 +/- 3.4%, 0/5 in the control; 24.2 +/- 10.5%, 14/14 in the preop-PD group; and 18.6 +/- 8.0, 13/13 in the post-PD group. The overall sensitivities in the preop- and post-PD groups were 100% for the recovery and 93% for the maximal mass ratio of the breath test, 89% for the secretin test, 67% for the BT-PABA test, and 64% for fecal chymotrypsin. The recovery of the breath test correlated significantly with the duodenal outputs of lipase, amylase, and chymotrypsin, and was not affected in patients with obstructive jaundice or with low D-xylose absorption. The breath test is as sensitive as the secretin test, more reliable than the conventional tubeless tests, and is available to follow up the exocrine pancreatic function before and after pancreatoduodenectomy.

Topics: 4-Aminobenzoic Acid; Adult; Aged; Breath Tests; Caprylates; Carbon Isotopes; Chymotrypsin; Duodenum; Feces; Female; Follow-Up Studies; Humans; Intestinal Secretions; Male; Middle Aged; Pancreatic Function Tests; Pancreaticoduodenectomy; para-Aminobenzoates; Reference Values; Secretin; Sensitivity and Specificity; Triglycerides

A 'screening' test is needed to identify patients with chronic pancreatitis among diabetics in tropical field surveys. We have examined the potential diagnostic yield of the BT-PABA/PAS test of exocrine pancreatic function in this setting. The recoveries of both PABA and PAS in eight healthy controls from Madras, south India, were lower than in controls from Manchester, north west England (mean +/- S.D., 51 +/- 11 vs. 79 +/- 7%, P < 0.001 for PABA; 52 +/- 11% vs. 81 +/- 7%, P < 0.001 for PAS) but the % PABA/PAS excretion index (PEI) was similar (0.96 +/- 0.14 vs. 0.96 +/- 0.06). Using a cut-off value of 0.75 for the PEI in a study group including eight patients with chronic pancreatitis and 26 with primary forms of diabetes, test sensitivity was 75%, specificity 92%, positive predictive value 75%, negative predictive value 92% and efficiency 88%.

Topics: 4-Aminobenzoic Acid; Aminosalicylic Acid; Chronic Disease; Chymotrypsin; Diabetes Complications; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Feces; Humans; India; Kinetics; Pancreatitis; para-Aminobenzoates; Tropical Climate

Topics: 4-Aminobenzoic Acid; Amylases; Caprylates; Chymotrypsin; Feces; Humans; Isoamylase; Pancreatic Diseases; Pancreatic Function Tests; para-Aminobenzoates; Secretin; Triglycerides

25 patients with chronic urticaria suspected to be of 'alimentary origin', were studied for a quantitative or qualitative deficiency of pancreatic enzyme secretion. All showed a normal fecal chymotrypsin excretion and 23/25 a normal bentiromide (PABA) and pancreolauryl test. In 2 females the urinary PABA and pancreolauryl tests were borderline pathological. This does not support the hypothesis that a pancreatic deficiency (of the kind which could be identified with the methods used) is associated with chronic urticaria in patients in whom improvement of urticaria occurs under a hydric or low antigenic diet.

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Feces; Female; Fluorescein; Fluoresceins; Humans; Pancreas; Pancreatic Function Tests; para-Aminobenzoates; Urticaria

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Chymotrypsin; Feces; Humans; Pancreatic Diseases; Pancreatic Function Tests; para-Aminobenzoates; Postoperative Period

Forty-six subjects (20 chronic pancreatitis, 7 chronic liver disease, 7 recovered from acute pancreatitis, 2 Crohn's disease, and 10 healthy controls) classified by S-C test as having normal pancreatic function (26 subjects), or moderate (10 subjects) and severe (10 cases) pancreatic insufficiency, were given, on different days, 1 g of oral PABA or 348 mg of oral fluorescein dilaurate. At the 1st, 2nd, and 4th hours (PABA) and the 2nd, 4th, and 6th hours (fluorescein) serum samples were taken for assay. In the presence of severe exocrine pancreatic insufficiency, the sensitivity of the fluorescein serum levels was higher than that observed for the PABA (100% and 80%, respectively), and quite similar to that shown by the urinary tests (100% and 70%, respectively). On the contrary, in presence of moderate pancreatic insufficiency, both the urinary test (pancreolauryl and (PABA) give a sensitivity higher than that found in the serum tests (30-40% and 10-30%, respectively). The parallel combination of both the serum or urinary tests does not significantly improve the sensitivity of the single test. These results suggest that the serum PABA and serum fluorescein tests can be valid choice when a prolonged urinary collection is difficult, i.e., in children and in elderly patients. However, the slight diagnostic gain does not justify the routine use of both urinary and serum tests.

Topics: 4-Aminobenzoic Acid; Adult; Aminobenzoates; Ceruletide; Chymotrypsin; Exocrine Pancreatic Insufficiency; Female; Fluorescein; Fluoresceins; Humans; Lipase; Male; Middle Aged; para-Aminobenzoates; Secretin

We examined the maximal serum PABA concentration within 3 hrs (MS-PABA) and the 6 hr urinary PABA recovery (6 hr U-PABA) after BT-PABA administration, PABA excretion index, and chymotrypsin secretory response to caerulein-secretin stimulation in ten control subjects and fifteen patients with chronic pancreatitis diagnosed on the basis of pancreatograms. The results suggested that MS-PABA can distinguish the patients with definite irregular dilatation of the main pancreatic duct from the controls, but not those with localized irregular dilatations of the side branches from the controls. MS-PABA showed a significant correlation with 6 hr U-PABA, PABA excretion index, chymotrypsin output and bicarbonate output. This modified method was shown to be useful in the diagnosis of chronic pancreatitis with unequivocally abnormal pancreatograms and/or markedly decreased chymotrypsin secretion. This modification will serve to simplify the BT-PABA test by eliminating urinary collection and shortening the procedure time.

Topics: 4-Aminobenzoic Acid; Adult; Aminobenzoates; Bicarbonates; Ceruletide; Chronic Disease; Chymotrypsin; Female; Humans; Male; Middle Aged; Pancreatitis; para-Aminobenzoates; Secretin

An investigation of fecal chymotrypsin activity on spot fecal specimens was carried out in three groups of subjects, divided as follows: 45 healthy controls (group C); 36 patients with gastroenterological diseases of extrapancreatic origin (group VP); and 42 patients with chronic pancreatitis (group CP). Nineteen patients of group CP underwent pancreozymin-secretin and NBT-PABA tests. The following results, expressed as mg of chymotrypsin/g of feces, were obtained: C = 0.610 +/- 0.203; CP = 0.291 +/- 0.154, p less than 0.001; VP = 0.560 +/- 0.234. FCT showed a sensitivity rate of 78.5% and a specificity rate of 71.6%. The fecal output of chymotrypsin correlated well with the pancreatic secretion of chymotrypsin (r = 0.59, p less than 0.01) and with the percentage of recovery of urinary PABA (r = 0.44, p less than 0.05). We conclude that chymotrypsin assay by the described method on spot stool specimens is a simple, reliable technique which may be considered a good screening test for pancreatic insufficiency. The test will not detect minimal pancreatic disease or minimal pancreatic dysfunction.

Topics: 4-Aminobenzoic Acid; Chymotrypsin; Clinical Enzyme Tests; Drug Stability; Exocrine Pancreatic Insufficiency; Feces; Humans; Pancreatic Juice; para-Aminobenzoates; Secretin

The changes in the residual function of the exocrine pancreas before and after the operation for chronic pancreatitis were examined with N-benzoyl-L-tyrosyl-p-aminobenzoic acid (NBT-PABA test) in 15 patients. The results of the NBT-PABA test classified by the surgical formula proved that no significant difference was found between the pancreatectomized group (pancreaticoduodenectomy and distal pancreatectomy) and the decompression group (pancreatojejunostomy and transduodenal exploration of the pancreatic duct), and no improvement on the outcome of the postoperative NBT-PABA test, as compared with the outcome of the preoperative test, was noted in both groups. When the state of the fibrosis of the pancreas was classified by the grade for comparison, it was observed that the outcome of the NBT-PABA test of grade 1, in which little fibrosis was made, was better than the outcome of the test of grade 3 before operation (p less than 0.01) and after operation (p less than 0.01). In each of the grades, however, no difference was found between the outcome of the preoperative NBT-PABA test, and that of the postoperative test. It was presumed from these findings that the residual function of the exocrine pancreas after operation was dependent largely on the degree of pancreatic fibrosis at operation.

Topics: 4-Aminobenzoic Acid; Adult; Aminobenzoates; Chronic Disease; Chymotrypsin; Humans; Middle Aged; Pancreas; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates

Twenty-five patients with chronic pancreatitis and 25 patients with non-pancreatic abdominal disorders were investigated by Lundh and BT PABA/14C-PABA tests of pancreatic function. The following results emerged: (1) There was a strong positive linear relationship between mean trypsin activity (MTA) and mean chymotrypsin activity (MCA) in duodenal aspirates after a Lundh test meal. (2) There was a strong positive linear relationship between chymotrypsin activity measured with BTEE, or BT PABA as substrate. (3) There was a strong positive correlation between MTA, or MCA, in duodenal juice after a Lundh meal and urinary PABA recovery, or the PABA/14C excretion index (PEI) in patients with chronic pancreatitis, but not in controls. (4) There was no correlation between the pH of duodenal juice in Lundh tests and PABA recovery, or PEI, in patients with or without pancreatic disease. We conclude that the Lundh and BT PABA/14C-PABA tests are equally discriminatory methods of assessing pancreatic exocrine function. The rate limiting effect of pH on BT PABA hydrolysis reported in in-vitro studies does not affect the practical clinical value of the BT PABA/14C-PABA test.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Chronic Disease; Chymotrypsin; Duodenum; Humans; Hydrogen-Ion Concentration; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Trypsin

The 6-h urine recovery of p-aminobenzoic acid (PABA) following the administration of a standard dose of N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BTPABA) was performed in 13 control subjects and two siblings with Shwachman's syndrome. The control subjects showed a recovery of 67 +/- 12.1% (mean +/- 1 SD) of the administered dose, consistent with previously reported values. Unexpectedly, the recovery of PABA in two siblings with Shwachman's syndrome was found to be 67 and 63%, respectively. The values are well within the normal range. In these siblings, fecal chymotrypsin activities were very low when measured with N-acetyl-L-tyrosyl-ethyl ester (ATEE) as substrate, but were normal when BTPABA was the substrate. The duodenal juice of the younger affected child following pancreozymin-secretin stimulation showed very low chymotrypsin activity against ATEE, BTPABA, and N-benzoyl-L-tyrosyl-ethyl ester. These findings suggest that there may be BTPABA-splitting activity in the lower bowel of these siblings with Shwachman's syndrome. This activity might be that of enteric bacteria or of the intestinal mucosa.

Topics: 4-Aminobenzoic Acid; Agranulocytosis; Aminobenzoates; Child; Child, Preschool; Chymotrypsin; Exocrine Pancreatic Insufficiency; Feces; Female; Humans; Infant; Male; Neutropenia; para-Aminobenzoates; Syndrome

Splitting activity of gastrointestinal mucosa was investigated by using N-benzoyl-L-tyrosyl-p-aminobenzoicacid (PABA-peptide) in 24 surgical materials obtained from all parts of the human gastrointestinal section. The highest activity was found in the adult jejunum (2.92-4.72 mIE/cm2 intact mucosa). The splitting activity of homogenates, prepared from correspondingly sized mucosa, always was 3-5 times higher than that of the intact mucosa; it was totally inhibited by NCDC, a specific inhibitor for chymotrypsin. The solid linkage and probably also the accumulation of very stable chymotrypsin on the mucosa seem to be responsible for the low sensitivity of the Pabapeptide-test. It is possible that the specificity of this test is considerably influenced by the dependency of the linkage capacity on the morphological structure of the mucosa.

Topics: 4-Aminobenzoic Acid; Adult; Aminobenzoates; Child; Chymotrypsin; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunum; para-Aminobenzoates; Protein Binding

Lundh test and PABA test results were compared in 50 patients. In the resulting correlation curve three areas of interest were differentiated: (1) an area with mean tryptic activity, found in the Lundh test, below 4 U/ml, where an abnormal PABA test result was also seen; (2) an intermediate area from 4 to 9 U/ml, where PABA test results may be found in discordance with the Lundh test; (3) the normal level, where PABA excretion was shown to be independent of intestinal chymotrypsin activity. In experiments in vitro on the kinetics of the hydrolysis of BTPABA by chymotrypsin the profound influence of the pH on Km and Vmax was shown. This influence of the pH explains why in the intermediate area of pancreatic dysfunction normal PABA test results were found in a number of cases. A higher mean pH level of the Lundh test aspirates was found for patients with a normal PABA test result than for patients with an abnormal PABA test.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Chymotrypsin; Clinical Enzyme Tests; Humans; Hydrogen-Ion Concentration; Hydrolysis; Intestinal Secretions; Kinetics; Pancreatic Function Tests; para-Aminobenzoates; Trypsin; Tyrosine

In 25 patients with chronic exocrine pancreatic insufficiency and 37 controls, the PABA test was compared with the concentration of chymotrypsin in stool. In additional 16 patients the test could not be evaluated (rate 21%). By determination of the PABA levels in serum before and one hour after ingestion of N-benzoyl-L-tyrosyl-PABA the test can be shortened and simplified: 1 hour serum levels in 9 patients with exocrine pancreatic insufficiency were 0.5 +/- 0.5 nMol/ml compared with 8 controls with 6.4 +/- 2.0 nMol/ml. PABA serum levels correlated significantly with chymotrypsin in stool. Compared with the conventional PABA test, since it is easily applicable in outpatients and the results are not influenced by medication or food.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Chymotrypsin; Exocrine Pancreatic Insufficiency; Humans; Pancreatic Function Tests; para-Aminobenzoates

Exocrine pancreatic insufficiency in the dog has been assessed by the oral administration of the synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA), a specific substrate for pancreatic chymotrypsin. The subsequent assay of PABA in either the plasma or the urine clearly differentiated control animals from those with exocrine pancreatic insufficiency (EPI), the results being unaffected by combination of this pancreatic function with a xylose absorption test. Possible interference with the specificity of the peptide test for the diagnosis of EPI was examined in six animals with small intestinal disease. In a group of four animals, with features resembling chronic tropical sprue in man, the results were comparable to those of the control group. In the fifth case, however, the results were indistinguishable from those of the EPI group, the estimation of sodium PABA absorption and the assay of proteolytic activity in the duodenal juice demonstrating that this was due to defective hydrolysis of the peptide. In the sixth case, diffuse intestinal lymphosarcoma and a marked villous atrophy were associated with an apparent reduction in the absorption of sodium PABA. However, although the plasma PABA concentrations following oral BT-PABA were subnormal, they were distinctly higher than those of the EPI group. These findings suggest that small intestinal abnormalities do not affect PABA absorption sufficiently to interfere with the specificity of the peptide test for the detection of severe EPI in the dog. This insufficiency may occasionally be secondary to small intestinal disease.

Topics: 4-Aminobenzoic Acid; Absorption; Aminobenzoates; Animals; Chymotrypsin; Dog Diseases; Dogs; Duodenum; Exocrine Pancreatic Insufficiency; Female; Intestinal Diseases; Intestinal Secretions; Lipid Metabolism; Male; Pancreatic Function Tests; para-Aminobenzoates; Trypsin; Xylose

Topics: 4-Aminobenzoic Acid; Administration, Oral; Aminobenzoates; Chymotrypsin; Humans; Pancreatic Diseases; Pancreatic Function Tests; para-Aminobenzoates; Tyrosine

Some tests of exocrine pancreatic function are based on the estimation of intestinal chymotryptic activity by using specific substrates such as N-benzoyl-L-tyrosyl-PABA (BT-P). In this study the action of a number of bacteria isolated from human or monkey intestines on BT-P was investigated. The monkeys studied had an intestinal flora closely resembling that of man. Except for Bacteroides, Proteus vulgaris No. 73, Proteus morgani No. 202, and Pseudomonas aeruginosa No. 76, significant splitting of BT-P did not take place when the common enteric microorganisms were tested. It was concluded that with the possible exception of bacterial overgrowth of the small bowel, microbial chymotryptic activity is not of importance.

Topics: 4-Aminobenzoic Acid; Animals; Bacteria; Bacteroides; Chymotrypsin; Haplorhini; Humans; Intestines; para-Aminobenzoates; Tyrosine; Vibrio cholerae

The synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid is specifically cleaved by chymotrypsin to Bz-Ty and PABA. The liberated PABA is absorbed and excreted in the urine. Accordingly, PABA recovery reflects intraluminal chymotrypsin activity and is an index of exocrine pancreatic function. This test was evaluated in 24 patients with cystic fibrosis to determine its role in the diagnosis of exocrine pancreatic insufficiency. Cumulative percent PABA recovery in six hours was significantly lower in CF patients compared with the control group. No overlap was noted between the two groups. There was good correlation between PABA recovery, fecal chymotrypsin activity, and coefficient of fat absorption. These findings indicate that PABA recovery is significantly reduced in patients with CF and steatorrhea and may prove a practical and reliable test of pancreatic insufficiency.

Topics: 4-Aminobenzoic Acid; Adolescent; Adult; Aminobenzoates; Child; Child, Preschool; Chymotrypsin; Cystic Fibrosis; Feces; Humans; Lipids; Pancreatic Diseases; para-Aminobenzoates