Diagnosis of exocrine pancreatic insufficiency from stool fat and weight

Diagnostic workup was performed in 118 patients with a chronic malassimilation syndrome. 45 patients had exocrine pancreatic insufficiency, 23 patients jejunal mucosal atrophy (mainly celiac disease), 36 patients increased enteral deconjugation of bile acids and as shown by the 14C-glycocholate breath test and in 14 patients with chronic diarrhea and steatorrhea the cause could not be determined. Eleven patients with irritable bowel syndrome served as controls. Stool fat and weight were determined in all patients. Classification function coefficient were calculated on the basis of a discriminant analysis, leading to a correct classification in 82.2% of the patients with pancreatic insufficiency, 67.8% in the patients with jejunal mucosal atrophy and 83.3% in the patients with increased enteral deconjugation of bile acids. Calculation of sensitivity, specificity and predictive value in the total group and in two randomized subgroups and the correct diagnosis of exocrine pancreatic insufficiency in 78.5% of the patients of an independent verification group suggest clinical usefulness of this approach mainly in the diagnosis of exocrine pancreatic insufficiency.