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Utility of Direct Pancreatic Function Testing in Children
Ligia Alfaro Cruz1, Andrea Parniczky, Allison Mayhew
1From the *Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; †Heim Pál Children's Hospital, Budapest; ‡1st Department of Medicine, University of Szeged, MTA-SZTE Momentum Translational Gastroenterology Research Group Institute for Translational Medicine, University of Pécs, Pécs, Hungary; §University of Cincinnati College of Medicine; and ∥Division of Biostatistics and Epidemiology, ¶Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Direct endoscopic pancreatic function testing (ePFT) effectively evaluates exocrine pancreatic insufficiency (EPI) in children. Pancreatic enzyme activity naturally increases with age, providing crucial normative data for diagnosing EPI in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Testing
- Pancreatic Function
Background:
- Exocrine pancreatic insufficiency (EPI) significantly impacts pediatric growth and nutrition.
- Accurate diagnosis of EPI is essential for timely intervention.
Purpose of the Study:
- To evaluate the utility of direct endoscopic pancreatic function testing (ePFT) in diagnosing EPI in children.
- Establish normative data for pancreatic enzyme activities in pediatric patients.
Main Methods:
- Retrospective chart review of 508 ePFTs performed between December 2007 and February 2015.
- Utilized two ePFT methods involving duodenal aspirate collection after secretin or cholecystokinin stimulation.
- Analyzed duodenal aspirates for pH and key pancreatic enzyme activities (trypsin, chymotrypsin, amylase, lipase).
Main Results:
- EPI was identified in 18.3% of pediatric patients.
- Pancreatic enzyme levels (trypsin, chymotrypsin, amylase, lipase) showed a significant increase with age (P < 0.05).
- Enzyme activity peaked at 5 minutes in multiple-sample tests.
Conclusions:
- Direct endoscopic pancreatic function testing (ePFT) is a valuable tool for evaluating EPI in children.
- Age-related normative data derived from ePFT are critical for accurate diagnosis.
- Findings support the maturation of pancreatic enzyme activities throughout childhood.
Objectives:
Exocrine pancreatic insufficiency (EPI) can have a significant impact on a child's growth and nutrition. Our aim was to evaluate the utility of direct endoscopic pancreatic function testing (ePFT) in pediatrics.
Methods:
A single-center retrospective chart review was performed of children who underwent ePFT from December 2007 through February 2015. Endoscopic pancreatic function testings were performed by 1 of 2 methods: (1) intravenous cholecystokinin, followed by the collection of a single duodenal aspirate at 10 minutes, or (2) intravenous cholecystokinin or secretin, followed by the collection of 3 duodenal aspirates at a 5, 10, and 15 minutes. Samples were tested for pH and enzyme activities.
Results:
A total of 508 ePFTs were performed (481 single-sample tests, 27 multiple-sample tests). Based on the multiple-sample group, enzyme levels for chymotrypsin, amylase, and lipase peaked at 5 minutes, followed by a decrease in activity over time. Exocrine pancreatic sufficiency was identified in 373 (73.4%) and EPI in 93 (18.3%). Exocrine pancreatic sufficiency analysis found all pancreatic enzyme activities significantly increase with age: trypsin, chymotrypsin, amylase, and lipase, (P < 0.05).
Conclusions:
Endoscopic pancreatic function testing can be used in the evaluation of EPI in children. Normative data suggest that pancreatic enzyme activities mature with age.
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