Exocrine pancreatic function and chronic unexplained dyspepsia. A case-control study

The aim of this study was to determine the prevalence of diminished mean tryptic activity (MTA) in duodenal juice of patients with nonulcer dyspepsia following injection of a Lundh test meal. Two separate studies were undertaken. The first examined a consecutive group of 100 patients with suspected pancreatic disease referred over a period of 2 yr. In these patients, receiver-operating-characteristic analysis was used to determine the point of best discrimination, which occurred at 7 microEq/mL/min when non-pancreatic disease patients were compared with those with chronic pancreatitis or pancreatic cancer. The second study involved 22 patients with endoscopically confirmed nonulcer dyspepsia. The MTA for the patients with unexplained dyspepsia did not differ from 17 healthy controls, but a further 16 pancreatic disease control patients had significantly decreased values (p less than 0.01). Six patients with unexplained dyspepsia (27%) had an MTA of 7 microEq/min/mL or less, indicating impaired pancreatic function, which was more frequent than in healthy controls (p = 0.02). These six patients had significantly different symptoms, being more likely to have pain radiating through to the back (p = 0.017) and pain waking them from sleep (p = 0.002), and less likely to have postprandial pain (p = 0.045). It was of interest that the alcohol intake was not greater in these six patients. It is concluded that pancreatic disease may explain the symptoms of some patients with nonulcer dyspepsia.