Relations between Pancreatic Enzyme Outputs and Malabsorption in Severe Pancreatic Insufficiency

TLDR

The study examined how steatorrhea and creatorrhea relate to lipase and trypsin secretion in chronic pancreatitis patients versus healthy controls. Patients and controls received a standard diet, had 48‑hour stool collections, and their pancreatic enzyme outputs were measured after duodenal amino‑acid perfusion and intravenous cholecystokinin‑pancreozymin stimulation. Steatorrhea appeared only when lipase output fell below 10 % of normal; creatorrhea only when trypsin output fell below 10 % of normal, indicating a large reserve capacity for enzyme secretion and explaining the late onset of malabsorption in chronic pancreatitis. Published in N Engl J Med 1973 (Vol.

Abstract

To investigate the functioning reserve capacity of the exocrine pancreas, we studied the relations of steatorrhea and creatorrhea to lipase and trypsin outputs in 17 patients with chronic pancreatitis and 33 healthy subjects. A standard diet was given, and stools were collected for 48 hours. Total enzyme outputs in response to duodenal perfusion of essential amino acids (78 mM) and intravenously administered cholecystokinin-pancreozymin (0.25 U per kilogram per minute) were compared in patients and in healthy subjects. Steatorrhea was not observed until lipase output was 10 per cent or less of normal; similarly, creatorrhea occurred only when trypsin outputs were less than 10 per cent of normal. These relations demonstrate the large reserve capacity for enzyme secretion by the exocrine pancreas and explain the often late development of steatorrhea and creatorrhea in chronic pancreatitis. (N Engl J Med 288:813–815, 1973)