alpha-chymotrypsin and Malabsorption-Syndromes

The hitherto existing results of determinations of enzymatic activities in stool are presented in this review. The chymotrypsin activity is diminished in advanced exocrine pancreatic insufficiency. The faecal alpha-amylase activity has up to now no significance in the diagnosis of pancreatic diseases. Up to five amylolytic enzyme activities are detectable. The alkaline phosphatase is mostly of intestinal origin. Up to 4 enzyme bands can be exhibited with the disc electrophoresis in polyacrylamide gel. Lysozyme and N-Acetyl-beta-D-glycosaminidase can also be detected in stool.

Topics: Alkaline Phosphatase; Amylases; Animals; Chymotrypsin; Colitis, Ulcerative; Cystic Fibrosis; Enzyme Induction; Feces; Hepatitis, Viral, Human; Hexosaminidases; Humans; Intestinal Mucosa; Malabsorption Syndromes; Muramidase; Pancreatic Diseases; Protozoan Infections; Rats; Trypsin

Direct measurement of pancreatic enzymes is the gold standard in the evaluation of exocrine pancreatic function. The purpose of our study was to evaluate the use of cholecystokinin as a single-agent secretagogue for pancreatic drainage studies. Twenty pediatric patients received cholecystokinin (group 1) and 40 patients received either secretin plus placebo (group 2) or secretin plus cholecystokinin (group 3). Duodenal fluid was collected for measurement of lipase, amylase, trypsin, chymotrypsin. The mean lipase and amylase activities were higher in group 3 and the mean trypsin and chymotrypsin activities were higher in group 1, but none of these observations were statistically significant. Group 3 had more patients with all four enzymes being normal (75%) compared to groups 1 (60%) and 2 (50%) (P = 0.262). Patients in all three groups had at least one normal enzyme. Cholecystokinin is useful as a single agent for direct pancreatic enzyme measurements in the absence of commercially available secretin.

Topics: Adolescent; Amylases; Child; Child, Preschool; Cholecystokinin; Chymotrypsin; Diagnosis, Differential; Drug Synergism; Failure to Thrive; Female; Humans; Infant; Lipase; Malabsorption Syndromes; Male; Pancreatic Function Tests; Pancreatic Juice; Pilot Projects; Prospective Studies; Secretin; Trypsin

Nutrient malabsorption frequently occurs in HIV infected children, but very few studies have investigated exocrine pancreatic digestive capacity in these cases.. To investigate pancreatic function in HIV infected children and to determine whether faecal fat loss, a prominent feature of intestinal dysfunction, is associated with pancreatic dysfunction.. Forty seven children with HIV infection without apparent pancreatic disease and 45 sex and age matched healthy controls.. Pancreatic function was evaluated by measuring elastase 1 concentration and chymotrypsin activity in stools by ELISA and colorimetric methods, respectively. Intestinal function was evaluated by measuring fat and protein loss by the steatocrit method and by faecal alpha1 antitrypsin concentration.. 14 (30%) had abnormal pancreatic function tests: seven had isolated elastase activity deficiency, three isolated chymotrypsin deficiency, and four pancreatic deficiencies in both enzymes. Patient enzyme values were significantly lower than those of controls. Low faecal pancreatic enzymes were not associated with symptoms. Twelve children had steatorrhoea and four had increased alpha1 antitrypsin. Steatorrhoea was significantly associated with reduced faecal pancreatic enzymes. There was a significant negative correlation between elastase 1 concentration and steatocrit. Children with pathological faecal elastase 1 or chymotrypsin values did not differ from the other HIV infected children with respect to nutritional and immunological status, stage of HIV disease, presence of opportunistic infections, or drug administration.. Abnormal pancreatic function tests are a frequent feature of paediatric HIV infection; this condition is associated with steatorrhoea, which probably contributes to the disease.

Topics: Adolescent; Case-Control Studies; Celiac Disease; Child; Child, Preschool; Chymotrypsin; Dietary Fats; Enzyme-Linked Immunosorbent Assay; Feces; Female; HIV Infections; Humans; Infant; Intestinal Absorption; Malabsorption Syndromes; Male; Pancreatic Diseases; Pancreatic Elastase; Prospective Studies

Day-old male, meat-type chicks raised in brooder batteries were infected by orally administering an inoculum prepared from intestines of broiler chicks infected with stunting syndrome (SS). Naive controls were kept in a parallel room. The chicks were fed a commercial starter diet supplemented with two levels of enzyme preparations to 14 d of age. The experiment was continued to the age of 6 wk in order to estimate compensatory feed intake and growth. In a parallel study, digestibility of the feed was determined from 1 to 3 wk of age with control or inoculated chicks. The enzymes amylase and proteases were produced by Bacillus subtilis and Penicillium emersonii. Enzyme supplementation had no effect on feed intake, growth, or feed utilization, or on digestibility of fat, starch, protein, or energy. Because enzyme supplementation did not consistently affect performance of chicks and no interactions were observed between enzyme supplementation and infection status, data are presented for effects of infection only. Inoculation of SS-infective material reduced performance to 4 wk. Compensatory growth and feed intake were observed from the age of 4 wk onward. At the age of 6 wk the slight retardation of the inoculated chicks was not significant. On Week 1, retention of fat, starch, protein, and energy was significantly depressed in the inoculated chicks. At the age of 2 wk, retention of starch was not depressed, and at the age of 3 wk, the only consistent depression was that observed for fat. The proventriculus weight and content were consistently higher in inoculated chicks, as were the small intestine and intestinal content. The pH of the gizzard content was higher, and that of the small intestine content was lower, in the inoculated birds than in their control counterparts. Stunting syndrome infection was accompanied by a significant depression of trypsin activity in the pancreas at the age of 1 and 2 wk. At these periods, amylase and chymotrypsin were not affected. At 6 wk of age, the activities of amylase, trypsin, and chymotrypsin in the pancreas were higher in the inoculated than in the control birds. In the intestinal chime, amylase, trypsin, and chymotrypsin activities were lower in the inoculated birds on Week 1 and 2 (NS for amylase on Week 1). On Week 6, the activity of all enzymes assayed was higher in the inoculated birds (NS for amylase). It is suggested that the main factors depressing feed intake and growth in SS-infected birds are most probably

Topics: Aging; Amylases; Animals; Chickens; Chymotrypsin; Dietary Fats; Dietary Proteins; Digestion; Digestive System; Digestive System Physiological Phenomena; Endopeptidases; Energy Metabolism; Food, Fortified; Gizzard, Avian; Intestine, Small; Malabsorption Syndromes; Male; Organ Size; Pancreas; Poultry Diseases; Proventriculus; Starch; Trypsin

Topics: Chymotrypsin; Cystic Fibrosis; Exocrine Pancreatic Insufficiency; Feces; Humans; Infant; Malabsorption Syndromes; Sensitivity and Specificity

The fecal chymotrypsin (FC) levels in samples collected over 24 h were determined by a new commercial colorimetric method from Boehringer Mannheim in 82 children suffering from various pancreatic disorders. The patients were divided into 4 groups, in accordance with the following etiologies: cystic fibrosis of the pancreas (CFP), chronic severe hepatic disorders (CSH), primary malabsorption syndrome (PMS) and malnutrition due to nondigestive causes (M). The control group comprised 48 children of similar ages. The 24th FC levels as U/g (mean +/- SD) were: 34 +/- 6 in the control group, 2 +/- 2 in the CFP group, 15 +/- 6 in the M group, 19 +/- 9 in the CSH group and 43 +/- 13 in the PMS group. The differences between the CFP patients and all the other groups were statistically significant. These results indicate that the FC levels may be suitable as a diagnostic indication of CFP and capable of differentiating between this disorder and other causes of pancreatic insufficiency.

Topics: Adolescent; Child; Child, Preschool; Chymotrypsin; Colorimetry; Cystic Fibrosis; Exocrine Pancreatic Insufficiency; Feces; Humans; Infant; Malabsorption Syndromes

The aim of this study was to assess the analytical performance of the BMC stool chymotrypsin test and its accuracy in diagnosing pancreatic disease in infants. The test utilizes a detergent which solubilizes chymotrypsin bound to stool residues, and a tetrapeptide coupled to p-nitroaniline which is specifically cleaved by chymotrypsin. We employed the IL Multistat at 30 degrees C to monitor enzyme activity as an increase in absorbance at 405 nm. The reaction was linear to 600 U/g stool. Recovery of exogenous chymotrypsin with a single detergent extraction was 98-105%, and of endogenous chymotrypsin (as determined by multiple extractions) 80-97%. Imprecision (CV) was 2.2% within-day and 2.4% between-day for the BMC control, and 2.4-5.2% for stool chymotrypsin in the range 8.3-14.4 U/g. Since the test utilises only 100 mg of stool, inhomogeneity of enzyme distribution was assessed by multiple assays on a single stool, which revealed a range of activity from 4.2-150%. We therefore recommend sampling of each stool in triplicate. With this procedure, chymotrypsin was measured in 220 consecutive stool samples submitted for fat determination from children. Applying the manufacturer's lower reference limit of 4.1 U/g, the following results were obtained (number abnormal/total number): suspected intestinal disease with normal stool fat (5/127); proven intestinal disease and increased stool fat (1/26); untreated cystic fibrosis (CF) with (19/22), and without (0/3) steatorrhea; CF with pancreatic insufficiency on replacement therapy (4/42).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Chymotrypsin; Cystic Fibrosis; Fats; Feces; Humans; Infant; Malabsorption Syndromes; Pancreatic Diseases; Photometry

The intraluminal transport of cobalamin (Cbl) remains controversial in chronic pancreatitis. We have determined the ability of intestinal juice to degrade the digestive holohaptocorrin (R binder) and the binding of endogenous Cbl in basal intestinal juice from 22 chronic pancreatitis patients and 22 controls. The intestinal juice from patients and controls degraded 34.7 +/- 32.3% and 95.2 +/- 7.2% of holohaptocorrin, respectively. This percentage was correlated with the trypsin output but not with the Schilling test. The unsaturated Cbl-binding capacity was similar in both groups. Respectively, 62.5 +/- 26.6% and 19.6 +/- 11.7% of endogenous Cbl was bound to haptocorrin in intestinal juice from patients and controls. These percentages were correlated with the Schilling test and with the ability of intestinal juice to degrade haptocorrin. We concluded that 1) the sequestration of Cbl to haptocorrin is one of the factors responsible for the malabsorption of crystalline Cbl in patients with chronic pancreatitis and 2) enterohepatic circulation of Cbl can be interrupted in some cases of chronic pancreatitis.

Topics: Adult; Aged; Chronic Disease; Chymotrypsin; Corrinoids; Humans; Intestinal Secretions; Intrinsic Factor; Malabsorption Syndromes; Middle Aged; Pancreatitis; Schilling Test; Trypsin; Vitamin B 12

Topics: alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; alpha-Macroglobulins; Body Fluids; Child; Child, Preschool; Chymotrypsin; Duodenum; Humans; Infant; Malabsorption Syndromes; Protease Inhibitors

Agarose gel electrophoresis (at pH 8.6) was used for qualitative determination of pancreatic enzymes in duodenal juice. The various enzymes were identified by staining techniques with specific chromogenic substrates, by quantitative determination of enzymes in eluates of gel slices, and by immunoelectrophoresis. The various protein bands corresponded to the following enzymes (from the anode to the cathode): chymotrypsin, trypsin, carboxypeptidase A, chymotrypsin, amylase (around the slit), lipase, elastase, and trypsin. The method was applied to a study of exocrine pancreatic function in 10 adults and 83 children suspected of having malabsorption. The duodenal juice, also analyzed for trypsin and amylase content, was collected in fasting condition and after a test meal of water. In patients with normal pancreatic function, all the enzyme bands were present and easy to recognize. In 87 patients carboxypeptidase A was present as two bands in 68 (80%), anodal trypsin as two bands in 39 (45%), and cathodal trypsin as two bands in 85 (97%). Electrophoresis of duodenal juice gave as much information from the fasting sample as after the test meal. Six children with pancreatic insufficiency (cystic fibrosis and Shwachmar's syndrome) had no or only faintly stained enzyme bands and a strongly stained albumin-containing band most anodally. The method is simple, rapid, and useful in routine work. The combination of this qualitative test with a quantitative one (e.g. trypsin determination) provides good information about exocrine pancreatic function.

Topics: Adolescent; Adult; Amylases; Carboxypeptidases; Celiac Disease; Child; Child, Preschool; Chymotrypsin; Duodenum; Electrophoresis; Electrophoresis, Agar Gel; Female; Food Hypersensitivity; Giardiasis; Humans; Immunoelectrophoresis; Infant; Malabsorption Syndromes; Male; Pancreatic Diseases; Pancreatic Elastase; Pancreatic Juice; Trypsin

Pancreatico-duodenectomy was performed in 11 patients for malignant or inflammatory tumours of the head of the pancreas or the region of the papilla. Digestive and endocrine functions were determined after the operation. In all cases faecal fat values were abnormal, indicating a 90% loss of pancreas. 14C-exhalation measurement, chymotrypsin determination in stool, and amylose tolerance test were also performed. Oral glucose-tolerance tests with plasma-insulin measurement indicated asymptomatic diabetes mellitus in the majority of patients. Two patients whose diabetes was controlled by tablets before the operation required insulin treatment afterwards. A decreased serum-gastrin level proved the existence of gastric and extragastric sources of gastrin.

Topics: Blood Glucose; Body Weight; Chymotrypsin; Duodenum; Feces; Gastric Juice; Gastric Mucosa; Glucose Tolerance Test; Humans; Insulin; Malabsorption Syndromes; Pancreas; Pancreatic Neoplasms; Postoperative Complications; Time Factors; Xylose

Topics: Aged; Alcoholism; Biopsy, Needle; Cholecystokinin; Chymotrypsin; Drainage; Duodenum; Eating; Fatty Liver; Feces; Female; Humans; Lipid Metabolism; Lipids; Liver; Liver Cirrhosis; Malabsorption Syndromes; Male; Middle Aged; Pancreas; Pancreatic Diseases; Secretin

Topics: Adolescent; Adult; Body Height; Body Weight; Carboxypeptidases; Carotenoids; Celiac Disease; Child; Chymotrypsin; Cystic Fibrosis; Dietary Fats; Feces; Growth; Humans; Intestinal Secretions; Lipase; Lipids; Malabsorption Syndromes; Nitrogen; Nutritional Physiological Phenomena; Pancreatin; Prognosis; Trypsin; Xylose

Topics: Aged; Alcoholism; Bicarbonates; Cholecystokinin; Chymotrypsin; Female; Humans; Liver Cirrhosis; Malabsorption Syndromes; Male; Middle Aged; Pancreas; Secretin

Topics: Animals; Chronic Disease; Chymotrypsin; Dog Diseases; Dogs; Malabsorption Syndromes; Pancreas; Pancreatic Diseases; Trypsin

Trypsin and chymotrypsin concentrations were determined in 180 spot stool specimens from 110 control patients in hospital. The lower limit of normality for each enzyme was placed at the 5% level: 95% of this population excreted feces containing more than 100 mug. of chymotrypsin and 30 mug. of trypsin per g. of feces. Chymotrypsin concentrations appeared to be a more reliable guide to pancreatic function than trypsin concentrations.Fecal chymotrypsin concentrations were subnormal in five patients with chronic pancreatitis, borderline in one patient with relapsing pancreatitis, subnormal in one patient after pancreatectomy, and subnormal in five of nine with carcinoma of the pancreas. Subnormal concentrations of fecal chymotrypsin were found in seven of 21 patients with chronic liver disease related to alcoholism, eight of 32 with a partial gastrectomy, three of 10 with adult celiac disease and five of 16 with psoriasis.It appears that the determination of fecal chymotrypsin concentrations provides a valuable screening test for pancreatic exocrine deficiency. However, normal results may be found in some patients with pancreatic disease and subnormal values may occur in some patients with other conditions.

Topics: Alcoholism; Chymotrypsin; Feces; Humans; Liver Cirrhosis; Malabsorption Syndromes; Pancreatic Diseases; Pancreatic Neoplasms; Pancreatitis; Skin Diseases; Trypsin

Topics: Adolescent; Autoanalysis; Child; Child, Preschool; Chymotrypsin; Cystic Fibrosis; Feces; Humans; Infant; Malabsorption Syndromes; Secretory Rate; Trypsin