Fecal chymotrypsin and trypsin determinations.

Area of Science:

• Gastroenterology
• Biochemistry
• Clinical Diagnostics

Background:

• Pancreatic exocrine insufficiency affects nutrient absorption and can indicate underlying pancreatic disease.
• Accurate diagnostic tools are crucial for timely intervention and management.
• Fecal enzyme levels offer a non-invasive method to assess pancreatic function.

Purpose of the Study:

• To evaluate the diagnostic utility of fecal trypsin and chymotrypsin concentrations.
• To establish normal reference ranges for fecal chymotrypsin and trypsin.
• To determine if fecal chymotrypsin is a reliable marker for pancreatic exocrine deficiency.

Main Methods:

• Analysis of 180 spot stool specimens from 110 hospital control patients.
• Determination of fecal trypsin and chymotrypsin concentrations using quantitative assays.
• Establishment of lower limits of normality at the 5% level for both enzymes.

Main Results:

• The lower limit of normality was established at >100 µg/g for chymotrypsin and >30 µg/g for trypsin.
• Fecal chymotrypsin concentrations were found to be a more reliable indicator of pancreatic function than trypsin.
• Subnormal fecal chymotrypsin was observed in patients with chronic pancreatitis, post-pancreatectomy, pancreatic carcinoma, alcoholism-related liver disease, post-gastrectomy, celiac disease, and psoriasis.

Conclusions:

• Fecal chymotrypsin determination is a valuable screening test for pancreatic exocrine deficiency.
• While useful, normal fecal chymotrypsin levels do not exclude pancreatic disease.
• Subnormal levels can occur in conditions other than pancreatic insufficiency, necessitating further investigation.