[Functional pancreatic studies in the diagnosis and treatment of chronic pancreatitis]

The diagnosis of chronic pancreatitis is usually established by clinical history and morphological criteria based on radiological and/or endoscopic (ERCP) findings. When these morphological signs are absent or equivocal, pancreatic function testing is necessary. Direct testing by duodenal intubation with hormonal stimulation is still considered as the reference method ("gold standard"). Numerous indirect tests have been introduced to replace the duodenal intubation which is rarely well accepted and difficult to repeat. Moreover this technique is only available in highly specialized centres. Among the tubeless tests, the Paba test and the pancreolauryl test are gaining interest. Several modifications of these tests have improved their sensitivity and specificity. In most instances, these tests are unable to detect mild pancreatic insufficiency. However their reproducibility in individual cases could be useful for the follow-up of patients with proven pancreatic insufficiency, particularly with regard to the efficacy and the compliance of replacement therapy.