Pancreatic Secretory Enzymes in the Diagnosis of Acute Pancreatitis

Abstract

During the past century great progress has been made in developing noninvasive methods, both imaging and biochemical, for the diagnosis of acute pancreatitis (AP). Computed tomography (CT) with contrast enhancement (CECT) [1] and ultrasonography (US) [2] are examples of recent diagnostic techniques which, along with clinical assement of the patient, provide the basis for a decision on therapy. CECT and US are usually not available in the emergency room. The diagnostic work-up of a patient with suspected AP always starts with laboratory tests. Laboratory tests for the diagnosis of AP are based on the assay of pancreatic secretory products and various other components in small samples of body fluids and tissues, which supposedly reflect the presence and extent of inflammatory changes in the pancreas and the consequences of these on the body. It should be noted that these biochemical tests yield only indirect evidence of the pathological process. New tests are continuously being explored, implying that the ideal test for diagnosing AP and monitoring its course has not yet been established. As early as in 1952, Thistlethwaite and Hill emphasized that in order to assess the value of any method for diagnosing AP, the presence of the disease must be objectively verified. At that time, pancreatic biopsy via laparotomy was the only feasible way to do this, while in fatal disease postmortem examination was done [3]. The principle of objective verification of the diagnosis of AP was rarely adhered to in clinical studies until the introduction of CT and US. Since 80% of patients with AP present an uncomplicated course, operation to verify diagnosis is usually not justified. The lack of a reliable reference method for the diagnosis of AP has created substantial difficulties in the interpretation of published reports [4].