trypsinogen and Intestinal-Diseases

EPI in dogs represents a well-defined condition that can now be diagnosed simply by the analysis of a single serum sample for TLI. A low TLI concentration represents a highly sensitive and specific test for EPI and may also predict the development of disease before the onset of clinical signs. A lack of pancreatic enzymes results in interference with degradation of the major dietary constituents, and there are secondary changes in the small intestine including a decreased synthesis of enterocyte proteins; bacterial overgrowth in the proximal intestine (SIBO); and malabsorption of vitamins, including cobalamin. Management with uncoated pancreatic extract and a low-fat, high-quality protein diet fed in small, divided meals should be effective in most cases. In animals showing a poor response, additional treatment may be necessary with long-term oral antibiotic for SIBO and H2-receptor blockers before a meal to inhibit acid secretion and minimize degradation of pancreatic extract. Diagnosis of the relatively rare cases of EPI in cats is best achieved by analysis of fecal trypsin by the use of specific substrates until a TLI test becomes readily available, and management should follow similar principles to those established for dogs. The major question for the future is the underlying cause of pancreatic acinar atrophy in dogs, particularly the relative importance of genetic and environmental factors. This information may allow detection and elimination of a genetic abnormality by selective breeding or prophylactic treatment that would prevent the development of the disease.

Topics: Animals; Dog Diseases; Dogs; Exocrine Pancreatic Insufficiency; Intestinal Diseases; Pancreatic Extracts; Sensitivity and Specificity; Trypsinogen

Topics: Base Sequence; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Gene Deletion; Heterozygote; Humans; Ileal Diseases; Infant, Newborn; Intestinal Diseases; Meconium; Models, Genetic; Molecular Sequence Data; Mutation; Neonatal Screening; Trypsinogen

The aim of this study was to evaluate pancreatic function in total parenteral nutrition (TPN)-dependent children with permanent intestinal failure by measuring immunoreactive trypsinogen (IRT) levels. Between 1992 and 1996, 105 pediatric patients with permanent intestinal failure were referred to the Children's Hospital of Pittsburgh for small intestinal transplant evaluation. Serum samples were available from 55 of them. Ten suffered from intestinal pseudo-obstruction or microvillus inclusion disease, while 45 had short bowel syndrome (SBS). IRT levels were significantly higher (p < 0.001) in SBS patients (89.4 +/- 9.2 ng mL) compared to controls (43.4 +/- 5.6 ng/ nL) without liver, gastrointestinal, or kidney disease. IRT levels did not correlate with liver injury, length of bowel, or the cause of SBS. Five of 20 patients who underwent intestinal transplantation developed pancreatitis during a median post-operative follow up 15.4 months later. IRT levels failed to predict who would develop pancreatitis post-transplant. The data suggest that elevated plasma IRT levels are common among children with intestinal failure, but fail to identify patients at risk for pancreatitis post-transplant.

Topics: Adolescent; Child; Child, Preschool; Enzyme-Linked Immunosorbent Assay; Female; Humans; Infant; Intestinal Diseases; Intestinal Pseudo-Obstruction; Intestines; Male; Pancreatitis; Parenteral Nutrition, Total; Risk Factors; Short Bowel Syndrome; Transplantation, Homologous; Trypsinogen

Topics: Diagnosis, Differential; Duodenum; Endopeptidases; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Diseases; Male; Metabolism, Inborn Errors; Pancreatic Diseases; Pancreatic Juice; Trypsinogen