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In twelve patients affected by small bowel bacterial overgrowth, diagnosed by means of the lactulose hydrogen breath test, the therapeutic efficacy of a non-absorbable derivative of rifamycin, rifaximin, was evaluated. This study showed that this drug has a satisfactory therapeutic efficacy in contaminated small bowel syndrome and, at the doses tested, is free of side-effects.

The secretion of bicarbonate, lipase, and chymotrypsin into the duodenum in response to exogenous stimulation with secretin, 1 CU/kg-h, plus caerulein, 100 ng/kg-h, was investigated in 12 patients, on an average, 20.7 months after total gastrectomy and in 14 control subjects. The secretion of bicarbonate and lipase was significantly lower in patients than in controls. The reduction in outputs compared with the control values was 47.9%, 38.7%, and 24.2% respectively for bicarbonate, lipase, and chymotrypsin. Eight of the 12 patients (67%) had steatorrhoea. No significant correlation was found between this parameter and lipase output. It is concluded that the exocrine pancreatic function is impaired in the majority of patients subjected to total gastrectomy. The impairment, which particularly affects bicarbonate and lipase, is generally mild to moderate.

We studied serum elastase 1 concentrations in patients with pancreatic disease to assess its diagnostic value and compare its sensitivity and specificity with that of amylase and pancreatic isoamylase. Markedly raised concentrations of elastase 1 were found in all twenty-nine patients with acute pancreatitis (amylase was elevated in all but three and pancreatic isoamylase in all but one). Serial measurements of the three enzymes in acute pancreatitis showed that elastase remained elevated longer than amylase and pancreatic isoamylase. The majority of chronic pancreatitis patients studied during a painful relapse (16 out of 21, 76 per cent) had elastase concentrations above the upper normal limit. Amylase and pancreatic isoamylase were elevated in 11 (52 per cent) and in 13 (62 per cent), respectively. Most patients with chronic pancreatitis studied during clinical remission (39 out of 43) had serum elastase levels either within (n = 24) or below (n = 15) the control range. The latter had severe exocrine pancreatic insufficiency and steatorrhoea. In carcinoma of the pancrease, 20 out of 32 (63 per cent) had abnormal serum elastase concentrations; 16 were higher and 4 lower than the control range. Amylase was abnormal in 10 (31 per cent) (8 high, 2 low), and pancreatic isoamylase was abnormal in 16 (50 per cent) (11 high, 5 low). In 46 control patients with non-pancreatic abdominal pain, serum elastase concentrations were not significantly different from those in healthy controls. Elastase was slightly raised in two, whereas amylase and pancreatic isoamylase were elevated in seven and eight, respectively. We conclude that serum elastase 1 is a highly sensitive and specific indicator of pancreatic disease.

Phosphorylcholine and homocysteine have an important choleretic action and also potentiate exocrine pancreatic secretion by way of stimulation and a more effective preparation of the substrate against attack by lipolytic enzymes. The protection offered by pancreatic enzymes in the correction of the digestive insufficiency in the endoluminal stage is also known. An analysis was therefore made of the action of an association of phosphorylcholine homocysteine and digestive enzymes in cases of exocrine pancreatic insufficiency and primary or secondary malabsorption. This action was evaluated on the basis of the reduction of elimination of steatorrhoea. For this purpose, faecal lipids were determined with the method proposed by van de Kramer et al. The most significant results were obtained in cases where digestive insufficiency was most marked, where correction of the pancreatic enzyme deficiency and improved biliary function were particularly required.

Serum trypsin-like immunoreactivity (TLI) was studied in 31 patients before and after endoscopic retrograde cholangiopancreatography. None of the patients developed clinical acute pancreatitis. Generally, the serum TLI peak was observed within the first 6 hours after the examination. Most patients (73%) showed a pathologically high TLI but very high values were not frequent (19%). Successful pancreatic opacification was followed by a significant increase in serum TLI which was pathologically high in nearly all cases (18/20). On the contrary, after cholangiography alone abnormal values were less frequent (4/8) and the increase was not significant. In most patients TLI and amylase responses were in agreement. A significant, though poor, linear relation was found between serum TLI and serum amylase 3, 6 and 12 hours after the examination.

The serum behavior of amylase, pancreatic isoamylase, lipase, trypsinogen, and elastase 1 was studied in 145 patients with pancreatic disease and in 66 patients with abdominal pain of nonpancreatic origin, for the purpose of evaluating the relative diagnostic utility of their assays. In 34 patients with acute pancreatitis, serum lipase, trypsinogen, and elastase 1 were elevated in all 34, pancreatic isoamylase in 33 (97%) and amylase in 30 (88%). Ten of these acute pancreatitis patients were followed sequentially for seven days: the variations in their serum enzyme levels were parallel, although the lipase, trypsinogen, and particularly the elastase 1 elevations persisted longer than did those of amylase and pancreatic isoamylase. Among the patients with chronic pancreatitis, either in painful relapse (N = 19) or with pancreatic cysts (N = 15), the respective percentages of enzymes elevations were: 79 and 80% for elastase 1, 68 and 67% for trypsinogen, 63 and 73% for pancreatic isoamylase, 58 and 60% for lipase, 53 and 60% for amylase. In the 52 chronic pancreatitis patients studied during clinical remission, serum enzyme behavior varied greatly, and a majority of the assays (60%) were normal; even in the case of severe pancreatic exocrine insufficiency, normal as well as abnormally high and low enzyme values were seen. Highly variable enzyme behavior was also seen in the 40 patients with pancreatic cancer, and elastase I was the most frequently (35%) elevated enzyme in this group as well. Among the patients with abdominal pain of nonpancreatic origin, abnormally high enzyme levels were present in percentages ranging from 6% for lipase to 21% for trypsinogen.(ABSTRACT TRUNCATED AT 250 WORDS)

We have measured serum immunoreactive pancreatic elastase 1 concentrations in 90 patients with pancreatic cancer in order to determine its usefulness in the diagnosis of this tumor. Abnormal elastase 1 concentrations were found in only 58 (64.4%) of the 90 patients. Fifty (55.5%) had abnormally high values, and eight (8.9%) had abnormally low values. No significant differences in elastase 1 levels were observed between patients with resectable cancer (n = 15) and those with unresectable cancer (n = 75). Moreover, no significant differences were found between elastase 1 concentrations of patients with pancreatic cancer and those of 71 patients with chronic pancreatitis. We conclude that serum elastase 1 measurement does not represent a significant advance in the diagnosis, whether early or late, of pancreatic cancer.

Pancreolauryl test (PLT), a tubeless pancreatic function test, was performed in 40 consecutive patients suffering from chronic pancreatitis, in 21 patients with miscellaneous digestive diseases, and in 18 control subjects to assess its diagnostic sensitivity and specificity. N-benzoyl-L-tyrosyl-p-aminobenzoic acid test (PABA test) and secretin-cerulein test were also carried out to compare the diagnostic value of PLT with that of these two pancreatic function tests. PLT was abnormal in 22 of 40 patients with chronic pancreatitis (55%). In particular, pathological results were found in all patients with severe pancreatic insufficiency and only in four of 14 patients with mild to moderate insufficiency. PABA test showed a slightly lower sensitivity in severe insufficiency, and the same sensitivity in mild-moderate insufficiency. PLT was normal in all control subjects and in 17 of 21 patients with nonpancreatic digestive diseases. Its specificity (90%) was slightly higher than that of PABA test (82%). The results indicate that PLT may be used to support a diagnosis of severe pancreatic exocrine insufficiency, while in mild or moderate insufficiency its diagnostic value is limited.

In view of the limited information concerning the influence of aging on exocrine pancreatic function, the authors undertook the present study. To examine a large number of elderly persons, including people of very advanced age (80 years and over), pancreatic function was studied by using the fluorescein dilaurate test (pancreolauryl test), one of the most recent tubeless, noninvasive pancreatic function tests. Sixty healthy noninstitutionalized elderly individuals (35 women and 25 men, aged 66 to 88 years, mean 78) participated in the study. Thirty-six healthy younger subjects (16 women and 20 men, aged 21 to 57 years, mean 36) were also studied as controls. All elderly subjects showed a strictly normal fluorescein dilaurate test. No significant differences in the pancreatic function test results were observed between the elderly under 80 years old and those over 80 years old. The authors conclude that the aging process per se does not significantly affect exocrine pancreatic function and, more particularly, does not impair the digestive capacity of the elderly person.

We have studied the effect of isometheptene, an indirectly acting sympathomimetic with analgesic and antispastic properties, on secretin-cholecystokinin-stimulated pancreatic and biliary outputs. Isometheptene, infused intravenously at a dose of 100 mg in 30 min, significantly inhibited bicarbonate, enzyme, and bilirubin output in eight healthy subjects (compared to control values, the maximum percent inhibition was 34% for bicarbonate, 57% for lipase, 61% for chymotrypsin, and 86% for bilirubin). In four cholecystectomized subjects, the drug inhibited only pancreatic outputs. The inhibitory effect on pancreatic secretion, coupled with the analgesic action, suggest a potential benefit of this drug in acute pancreatic pathology.