Basal chymotrypsin secretion and the bentiromide test in chronic pancreatitis
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The bentiromide test appears to be useful in detecting chronic pancreatitis with measurements of urinary excretion of PABA after the oral administration of BT-PABA. Although the bentiromide test may reflect abnormal pancreatic chymotrypsin secretion, the test has not previously been correlated with basal pancreatic chymotrypsin secretion. Normal volunteers and patients with chronic pancreatitis underwent the bentiromide test (500 mg) and intubation with a multilumen duodenal catheter. Duodenal juice was analyzed for chymotrypsin, and the content, concentration, and output were determined. In addition, the ability of the duodenal juice to generate PABA from BT-PABA was measured and correlated with the other secretory studies. Normal subjects had a urinary PABA excretion of 81.4 ± 4.1 %. Two groups of subjects with chronic pancreatitis were identified, one with a normal mean PABA excretion, 73.9±9%, and the other with a decreased mean PABA excretion, 35.5 ±5%. The basal chymotrypsin output of 18.2±8 U/min and the duodenal juice generation of PABA, 0.1 ±.04 ug/mL in the subjects with chronic pancreatitis were both less than found in normals, 105.1 ±48.6 U/min and 0.4 ±.04 μg/mL (p<.05). The percent PABA excretion did not correlate significantly with the three basal secretory studies. Duodenal juice PABA generation correlated only with the basal concentration of chymotrypsin (r = 7, p<.01). It appears that the bentiromide test, although capable of detecting subjects with chronic pancreatitis, may not accurately reflect the amount of basal duodenal chymotrypsin.
Key WordsChymotrypsin bentiromide chronic pancreatitis
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