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Secretin-cerulein test and fecal chymotrypsin concentration in children with intestinal giardiasis
A Carroccio1, G Iacono, G Montalto
1Cattedra Di Medicina Interna, Universitá Di Palermo, Italy.
Insights
Giardiasis patients generally show normal pancreatic function and fecal chymotrypsin. However, one patient with intestinal villi atrophy had reduced enzyme levels, which normalized after Metronidazole treatment.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Infectious Diseases
Background:
- Giardiasis is a common intestinal infection.
- Pancreatic exocrine function in giardiasis is not well-understood.
- Assessing exocrine function aids in understanding disease impact.
Purpose of the Study:
- To evaluate pancreatic exocrine function in children with giardiasis.
- To correlate intestinal histology with pancreatic function tests.
- To assess the effect of treatment on pancreatic function.
Main Methods:
- Secretin-cerulein test to measure pancreatic secretions (chymotrypsin, lipase, phospholipase, bicarbonate).
- Intestinal biopsy to assess mucosal morphology.
- Fecal chymotrypsin assay for exocrine function.
- Comparison between giardiasis patients and healthy controls.
Main Results:
- Most giardiasis patients had normal intestinal biopsies and pancreatic function tests.
- One patient with partial villous atrophy showed reduced enzyme outputs and fecal chymotrypsin.
- Fecal chymotrypsin normalized after Metronidazole treatment in that patient.
Conclusions:
- Giardiasis typically does not impair pancreatic exocrine function.
- Severe intestinal involvement in giardiasis may be associated with reduced pancreatic enzyme secretion.
- Pancreatic function can recover after successful treatment.
Abstract:
We studied six patients with giardiasis (five males, one female), median age 3.5 yr (range 1-11) and 12 healthy control subjects (10 males, 2 females), median age 3.5 yr (range 1-10). Intestinal biopsy and a contemporaneous secretin-cerulein test were performed in all patients, and fecal chymotrypsin was also assayed. Intestinal biopsy was normal in five of the six patients with giardiasis, whereas one of the six presented a partial atrophy of the intestinal villi. The secretin-cerulein test (1 CU/kg of secretin + 75 ng/kg of cerulein) did not show any significant difference between values in the outputs of chymotrypsin, lipase, phospholipase, and bicarbonate obtained in patients and in controls; however, in the one patient with partial intestinal mucosal atrophy, all enzymatic activity levels were below the normal limit for our laboratory. Furthermore, the mean values of fecal chymotrypsin concentration did not differ between the two groups. Fecal chymotrypsin was also reduced in the patient with an abnormal secretin-cerulein test; a second assay performed 3 mo after the suspension of treatment (Metronidazole), however, showed a normal chymotrypsin concentration.