cholecystokinin and bentiromide

This article reviews the evolution of functional testing of the pancreas in Japan for the diagnosis and treatment of chronic pancreatitis (CP), contrasting the pre- with the postsecretin test (S test) era. In the pre-S test era, the diagnosis was based on symptoms, clinical findings, fasting serum diastase levels, and the vagostigmin- and ether-stimulation test unless morphologic evidence was available. The S test and CCK-pancreozymin (PZ) test (PS test) were introduced into Japan around 1963 and have been used as the gold standard of the exocrine pancreatic-function test. Through a series of attempts at standardization in 1971, 1985, and 1987, the method was standardized to collect duodenal juice for 60 min through a double- or triple-lumen tube after a bolus or during a continuous i.v. injection of secretin (100 U). The S test, however, is an invasive and cumbersome procedure. As a result, N-benzoyl-L-tyrosal-p-aminobenzoic acid (BT-PABA) testing and fecal chymotrypsin testing were introduced into Japan in the middle and late 1970s, respectively. Although simple and noninvasive, these two methods were found have lower sensitivity and specificity than the conventional S test. These two methods, therefore, are presently used more often for monitoring the course of disease and therapeutic effects. Additionally, the glucose tolerance test can be performed to detect endocrine pancreatic insufficiency.

Topics: 4-Aminobenzoic Acid; Absorption; Cholecystokinin; Chronic Disease; Digestion; Humans; Islets of Langerhans; Japan; Pancreatitis; para-Aminobenzoates; Secretin

Topics: 4-Aminobenzoic Acid; Animals; Cholecystokinin; Clinical Enzyme Tests; Diagnosis, Differential; Duodenum; Feces; Humans; Intestinal Secretions; Pancreatic Diseases; Pancreatic Function Tests; Pancreatic Juice; para-Aminobenzoates; Secretin

By means of loxiglumide, a potent and highly specific antagonist for cholecystokinin (CCK), the effects of blocking CCK receptors on gastrointestinal motility were investigated in a placebo-controlled study in healthy young men (aged 21-39, mean 24 years). Gallbladder contraction stimulated by ingestion of a liquid test meal was completely abolished by oral administration of loxiglumide 30 min before the test meal. Gastric emptying of radio-opaque markers ingested with the test meal was significantly accelerated by loxiglumide (area under the curve [markers x h] 33.3 [SEM 3.8] vs 17.9 [2.7] after placebo). No effect of loxiglumide was found on small-bowel transit time, but 7 days' treatment with oral loxiglumide (800 mg three times daily) significantly shortened colonic transit time (29.4 [4.1] h after placebo, 15.0 [3.4] h after loxiglumide). It is concluded that CCK is an important mediator of meal-induced gallbladder contraction and is involved in the regulation of gastrointestinal motility in man.

Topics: 4-Aminobenzoic Acid; Administration, Oral; Adult; Cholecystokinin; Clinical Trials as Topic; Colon; Drug Evaluation; Eating; Gallbladder; Gastric Emptying; Gastrointestinal Transit; Homeostasis; Humans; Infusions, Intravenous; Intestine, Small; Male; para-Aminobenzoates; Proglumide; Random Allocation; Receptors, Cholecystokinin

The clinical usefulness of a simple exocrine pancreatic function diagnostic test (PFT) was examined by the oral administration of 500 mg of N-benzoyl-L-tyrosyl-p-aminobenzoic acid. Recovery of p-aminobenzoic acid (PABA) in the urine was significantly lower in patients with calcifying chronic pancreatitis (58.6%) and noncalcifying chronic pancreatitis (68.6%) than in healthy normal subjects (81.0%; p less than 0.001 and p less than 0.05, respectively). Abnormally low values were demonstrated in 15 out of 19 (78.9%) chronic pancreatitis cases. In comparing the PFT with the pancreozymin secretin test, a good correlation (P less than 0.001) with maximum bicarbonate concentration was detected. In cases which were abnormal with respect to the PFT, the recovery rate of PABA was increased by the administration of antacids or digestive enzyme preparations (average increase of 24.1 or 29.8%, respectively). These results suggest that this test is also useful for the evaluation of therapeutic effects in patients with pancreatic diseases.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Cholecystokinin; Chronic Disease; Clinical Trials as Topic; Humans; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates

Serum fluorescein and p-aminobenzoic acid were measured during a urine pancreolauryl and an N-benzoyl-l-tyrosyl-p-aminobenzoic acid (NBT-PABA) test in 22 healthy controls, 17 patients with gastrointestinal nonpancreatic diseases (normal secretin-pancreozymin test), and 31 patients with abnormal exocrine pancreatic function due to chronic pancreatitis. The optimal cutoff point for separating normal from abnormal pancreatic function was after 210 min in the pancreolauryl test and after 150 min in the NBT-PABA test. The latter test was slightly less sensitive and specific than the pancreolauryl test. Serum tests seem to offer a practicable alternative to the established indirect pancreatic function tests in urine and may be used in the elderly and severely ill, as well as in outpatients in whom correct collection of the urine may be difficult.

Topics: 4-Aminobenzoic Acid; Aminobenzoates; Cholecystokinin; Exocrine Pancreatic Insufficiency; Feces; Fluoresceins; Humans; Indicators and Reagents; Pancreatic Function Tests; para-Aminobenzoates; Secretin

The oral (PABA) pancreatic function test (PFT), the secretin-pancreozymin test and endoscopic retrograde pancreatography (ERCP) have been carried out in 32 patients with suspected chronic alcohol induced pancreatitis (CAIP) in order to evaluate which, if any, test was most likely to confirm the provisional diagnosis. Thirty one patients had changes of minimal (n = 6) moderate (n = 7) or advanced (n = 18) chronic pancreatitis on pancreatography, whilst one patient had a pancreas divisum. Eight hour urinary PABA excretion was significantly reduced in patients with moderate and advanced structural changes (p less than 0.001) and correlated significantly with all parameters of the PFT, although eight patients with an abnormal pancreatogram and pancreatic function test had a normal PABA value. The PFT was abnormal in 23 patients, but normal in five patients with an abnormal pancreatogram and low PABA value. Most patients with minimal change pancreatitis had a normal PABA test and PFT. We conclude that pancreatography appears to be the most sensitive method for detecting chronic pancreatic damage and for confirming a clinical diagnosis of chronic alcohol induced pancreatitis. Both the PFT and PABA test are useful confirmatory tests and whilst the PFT is slightly more sensitive for assessing pancreatic exocrine function, the PABA test is well tolerated and simple to perform. It may therefore be the complementary investigation of choice for this group of patients.

Topics: 4-Aminobenzoic Acid; Adult; Alcoholism; Calcinosis; Cholangiopancreatography, Endoscopic Retrograde; Cholecystokinin; Chronic Disease; Female; Humans; Male; Middle Aged; Pancreatic Function Tests; Pancreatitis; para-Aminobenzoates; Secretin

A new test using N-benzoyl-L-tyrosyl-p-aminobenzoic acid (N-BT-PABA) for an evaluation of exocrine pancreatic function was compared with a pancreozymin-secretin test in 38 subjects. Urinary recovery of PABA, which is absorbed from the intestine and conjugated in the liver after an oral administration of N-BT-PABA, depends mainly on chymotrypsin activity. The recovery rate of PABA in urine decreases in chronic pancreatitis, in which chymotrypsin activity in the duodenal juice is disturbed. The recovery rate of PABA in calcifying chronic pancreatitis was 40.2 +/- 15% and significantly less than 81.2 +/- 7.4% in normal subjects (P less than 0.01). The amount of PABA in urine during eight hours was correlated with parameters of volume output- bicarbonate concentration and amylase output stimulated by injections of pancreozymin and secretin (P-S test). The new test using N-BT-PABA is useful for the evaluation of exocrine pancreatic function in general practice.

Topics: 4-Aminobenzoic Acid; Adult; Aged; Aminobenzoates; Cholecystokinin; Chronic Disease; Female; Humans; Male; Methods; Middle Aged; Pancreatitis; para-Aminobenzoates; Secretin