Abstract
There is a pressing need for a simple non-invasive test of exocrine pancreatic function for use in children. The pancreolauryl test has been modified by the addition of a second marker (mannitol) to achieve a single day test without the need for two timed urine collections. Six healthy subjects and nine patients with cystic fibrosis were studied. Fluorescein, fluorescein dilaurate, and mannitol were taken by mouth, alone or in combinations, followed by 10 hour urine collections in two hourly aliquots to study the comparative pharmacokinetics of these markers. Urinary fluorescein was determined spectrophotometrically and urinary mannitol enzymatically. When fluorescein dilaurate and mannitol were taken together and the results expressed as ratios of percentage fluorescein to percentage mannitol recovery (F:M ratio) (mean (SD)) there was clear discrimination between healthy subjects and those with cystic fibrosis regardless of enzyme replacement treatment (57.3 (18.2) v 3.4 (1.4) v 3.2 (1.6) respectively). The differences in F:M ratios reached statistical significance in urinary aliquots collected between two and eight hours after marker ingestion. This single day tubeless test will greatly simplify the investigation of the child with suspected exocrine pancreatic dysfunction.
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- Barry R. E., Barry R., Ene M. D., Parker G. Fluorescein dilaurate--tubeless test for pancreatic exocrine failure. Lancet. 1982 Oct 2;2(8301):742–744. doi: 10.1016/s0140-6736(82)90924-2. [DOI] [PubMed] [Google Scholar]
- Barry R. E., Behrendt W. A. Studies on the pharmacokinetics of fluorescein and its dilaurate ester under the conditions of the fluorescein dilaurate test. Arzneimittelforschung. 1985;35(3):644–648. [PubMed] [Google Scholar]
- Brown G. A., Sule D., Williams J., Puntis J. W., Booth I. W., McNeish A. S. Faecal chymotrypsin: a reliable index of exocrine pancreatic function. Arch Dis Child. 1988 Jul;63(7):785–789. doi: 10.1136/adc.63.7.785. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cavallini G., Piubello W., Brocco G., Vantini I., Angelini G., Benini L., Chech G., Marchiaro G., Dobrilla G., Bonoldi C. Reliability of the Bz-Ty-PABA and the pancreolauryl test in the assessment of exocrine pancreatic function. Digestion. 1983;27(3):129–137. doi: 10.1159/000198942. [DOI] [PubMed] [Google Scholar]
- Cumming J. G., Forsyth J. S., Boyd E. J., Frost G. J., Cuschieri A. Diagnosis of exocrine pancreatic insufficiency in cystic fibrosis by use of fluorescein dilaurate test. Arch Dis Child. 1986 Jun;61(6):573–575. doi: 10.1136/adc.61.6.573. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dalzell A. M., Heaf D. P. Fluorescein dilaurate test of exocrine pancreatic function in cystic fibrosis. Arch Dis Child. 1990 Jul;65(7):788–789. doi: 10.1136/adc.65.7.788. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gould S. R., Chinn G. L., Nobbs B. T., Lewis G. A. Evaluation of a tubeless pancreatic function test in patients with steatorrhoea in a district general hospital. J R Soc Med. 1988 May;81(5):270–273. doi: 10.1177/014107688808100511. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grim E., Simonds A., Oeljen C., Cheng J. Inulin and mannitol distribution volumes in canine small intestinal tissues in vivo. Am J Physiol. 1973 Jan;224(1):186–190. doi: 10.1152/ajplegacy.1973.224.1.186. [DOI] [PubMed] [Google Scholar]
- Laker M. F., Bull H. J., Menzies I. S. Evaluation of mannitol for use as a probe marker of gastrointestinal permeability in man. Eur J Clin Invest. 1982 Dec;12(6):485–491. doi: 10.1111/j.1365-2362.1982.tb02230.x. [DOI] [PubMed] [Google Scholar]
- Lankisch P. G., Schreiber A., Otto J. Pancreolauryl test. Evaluation of a tubeless pancreatic function test in comparison with other indirect and direct tests for exocrine pancreatic function. Dig Dis Sci. 1983 Jun;28(6):490–493. doi: 10.1007/BF01308149. [DOI] [PubMed] [Google Scholar]
- Lunn P. G., Northrop C. A., Northrop A. J. Automated enzymatic assays for the determination of intestinal permeability probes in urine. 2. Mannitol. Clin Chim Acta. 1989 Aug 15;183(2):163–170. doi: 10.1016/0009-8981(89)90332-x. [DOI] [PubMed] [Google Scholar]
- Malfertheiner P., Peter M., Junge U., Ditschuneit H. Der orale Pankreasfunktionstest mit FDL in der Diagnose der chronischen Pankreatitis. Klin Wochenschr. 1983 Feb 15;61(4):193–198. doi: 10.1007/BF01488974. [DOI] [PubMed] [Google Scholar]
- Meyer-Bertenrath J. G. Lipolytic enzymes of the human pancreas. I. A highly sensitive, specific, and simple measurement of cholesterol ester hydrolase activity. Enzyme. 1982;28(4):336–342. [PubMed] [Google Scholar]
- Murphy M. S., Eastham E. J., Nelson R., Aynsley-Green A. Non-invasive assessment of intraluminal lipolysis using a 13CO2 breath test. Arch Dis Child. 1990 Jun;65(6):574–578. doi: 10.1136/adc.65.6.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murphy M. S., Sheldon W., Brunetto A., Pearson A. D., Laker M. F., Eastham E. J., Nelson R. Active and passive sugar absorption in pancreatic insufficiency. J Pediatr Gastroenterol Nutr. 1989 Feb;8(2):189–194. doi: 10.1097/00005176-198902000-00011. [DOI] [PubMed] [Google Scholar]
- Nasrallah S. M., Iber F. L. Mannitol absorption and metabolism in man. Am J Med Sci. 1969 Aug;258(2):80–88. doi: 10.1097/00000441-196908000-00003. [DOI] [PubMed] [Google Scholar]
- Neis P., Zeuss F. Uber die Anwendbarkeit von Fluorescein-Dilaurat zur exokrinen Pankreasfunktionsprüfung bei Kindern. Monatsschr Kinderheilkd. 1981 Jun;129(6):347–348. [PubMed] [Google Scholar]
- Puntis J. W., Berg J. D., Buckley B. M., Booth I. W., McNeish A. S. Simplified oral pancreatic function test. Arch Dis Child. 1988 Jul;63(7):780–784. doi: 10.1136/adc.63.7.780. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Saunders D. R., Wiggins H. S. Conservation of mannitol, lactulose, and raffinose by the human colon. Am J Physiol. 1981 Nov;241(5):G397–G402. doi: 10.1152/ajpgi.1981.241.5.G397. [DOI] [PubMed] [Google Scholar]
- Schönberger W., Weitzel D. Diagnose der exokrinen Pankreasinsuffizienz mit Fluorescein-Dilaurat bei Patienten mit cystischer Fibrose. Monatsschr Kinderheilkd. 1980 Apr;128(4):195–198. [PubMed] [Google Scholar]
- Ventrucci M., Gullo L., Daniele C., Priori P., Labò G. Pancreolauryl test for pancreatic exocrine insufficiency. Am J Gastroenterol. 1983 Dec;78(12):806–809. [PubMed] [Google Scholar]
- Weaver L. T., Chapman P. D., Madeley C. R., Laker M. F., Nelson R. Intestinal permeability changes and excretion of micro-organisms in stools of infants with diarrhoea and vomiting. Arch Dis Child. 1985 Apr;60(4):326–332. doi: 10.1136/adc.60.4.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weaver L. T., Laker M. F., Nelson R. Intestinal permeability in the newborn. Arch Dis Child. 1984 Mar;59(3):236–241. doi: 10.1136/adc.59.3.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weaver L. T. The impact of milk and weaning diet on gastrointestinal permeability in English and Gambian infants. Trans R Soc Trop Med Hyg. 1988;82(5):784–789. doi: 10.1016/0035-9203(88)90236-2. [DOI] [PubMed] [Google Scholar]