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Usefulness of random fecal alpha 1-antitrypsin and chymotrypsin determinations in children
Insights
Fecal chymotrypsin is useful for diagnosing pancreatic insufficiency in children, even with diarrhea. Acute gastroenteritis can elevate fecal alpha 1-antitrypsin (FA-1-AT), mimicking Crohn
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Diagnostics
- Pancreatic Function Testing
Background:
- Assessing pancreatic exocrine function is crucial in pediatric gastrointestinal disorders.
- Fecal chymotrypsin and fecal alpha 1-antitrypsin (FA-1-AT) are non-invasive markers.
- Differentiating causes of diarrhea and protein loss requires reliable diagnostic tools.
Purpose of the Study:
- To evaluate the diagnostic utility of fecal chymotrypsin and FA-1-AT in children with various gastrointestinal conditions.
- To determine the impact of acute and chronic diarrhea on these fecal markers.
- To assess FA-1-AT as a potential indicator of protein loss in pediatric patients.
Main Methods:
- Fecal chymotrypsin activity and FA-1-AT concentrations were measured.
- Patient groups included cystic fibrosis, Crohn's disease, chronic aspecific diarrhea, acute gastroenteritis, and healthy controls.
- Statistical comparison of marker levels across different pediatric cohorts.
Main Results:
- Cystic fibrosis patients exhibited very low fecal chymotrypsin, distinct from diarrhea groups.
- FA-1-AT levels were significantly elevated only in children with Crohn's disease compared to controls.
- Acute gastroenteritis showed elevated FA-1-AT in 12% of cases, while chronic diarrhea and cystic fibrosis did not.
Conclusions:
- Fecal chymotrypsin remains clinically useful for diagnosing pancreatic insufficiency, unaffected by acute or chronic diarrhea.
- Acute gastroenteritis can cause transient protein loss, leading to elevated FA-1-AT levels.
- FA-1-AT elevations are specific to Crohn's disease in this pediatric cohort, distinguishing it from other diarrheal conditions.
Abstract:
Random fecal chymotrypsin activity and fecal alpha 1-antitrypsin (FA-1-AT) concentrations were determined in 11 children with cystic fibrosis, 5 children with Crohn's disease, 9 children with chronic aspecific diarrhea, 85 children with acute gastroenteritis, and 54 control children. Cystic fibrosis patients showed only very low fecal chymotrypsin values that did not overlap with values obtained in patients with either acute or chronic diarrhea. When compared with our control group, a significant increase of FA-1-AT concentrations was found only in children with Crohn's disease. Normal values were found in all patients with either chronic aspecific diarrhea or cystic fibrosis, while 12 of 85 children with acute gastroenteritis showed FA-1-AT concentrations above the 95th percentile of control children. We conclude that diarrhea (either acute or chronic) does not significantly decrease the clinical usefulness of fecal chymotrypsin activity measurements in the diagnosis of pancreatic insufficiency, while acute (gastroenteritis) but not chronic (chronic aspecific diarrhea, cystic fibrosis) diarrhea can give rise to protein losing and FA-1-AT concentrations similar to those found in Crohn's disease.
