Pancreatic Enzymes and Tests for Pancreatic Enzyme Production

How Do Enzymes Help In Digestion?

Our teeth breakdown food into small pieces when we chew food. This is first step of process food digestion, as chewed pieces of food are quiet too large to be absorbed by the body. Food has to be broken down chemically into really small pieces before it can be absorbed. Enzymes are the biological catalysts required to make this happen quickly enough to be useful.

Enzymes

Pancreatic enzymes helps to breakdown fats, proteins and carbohydrates. A normal functioning pancreas produce about 8 cups of pancreatic juice into the duodenum, daily and this fluid contains pancreatic enzymes to help with digestion and bicarbonate to neutralize stomach acid as it enters the small intestine.

 Tests for Pancreatic Enzyme Production

These tests are not very accurate; very few patients actually require them and different institutions use different tests. They are available in specialist pancreas units. These include:

  • Fecal Elastase Test

Elastase is one of the enzymes produced by the pancreas to digest protein. There is always a small extra amount produced which can be measured in the stool. The extra amount of elastase produced is related to the amount of normal pancreatic function. The fecal elastase test is used for screening and monitoring. More complicated tests may also need to be used if the final diagnosis is not clear.

  • PLT or Pancreato-Lauryl Test

A standard meal is taken following an overnight fast along with a test ‘food’ (with PLT). One or more blood tests or a urine test is then made to see if the test ‘food’ has been digested (by the pancreatic enzymes) and then absorbed.

  • Triolein Breath Test

This is a more specific test for fat digestion and absorption and is fairly simple to perform.

Triolein is a fat, which contains a minute trace of radioactive carbon. The amount of fat metabolized is determined by taking a simple breath test at a fixed time following ingestion of a small amount of triolein.

  • Fecal Fat Test

This is a good way of determining fat digestion but involves collecting stools for 1-3 days. As you can imagine this is not popular with either patients or the laboratory staff who have to make the measurement. (Pancreatic enzymes present in the stool can be measured simultaneously.)

  • Secretin Test

This is performed in only a few very specialist pancreas units and is very accurate (like the fecal fat test). After an overnight fast a special tube is passed through the nose into the stomach and the farthest part of the duodenum. The tube has two separate ‘pipes’, which drain fluid from the stomach and duodenum. The fluid from the duodenum contains the pancreatic enzymes and bicarbonate. Following the first 30-40 minutes an injection into a vein is given to stimulate the pancreas to produce enzymes and bicarbonate. The injection contains the hormones CCK-PZ (cholecystokinin-pancreozymin) and secretin. Further collections of fluid are then made to see how well the pancreas has been stimulated. The whole test lasts 3-4 hours and is usually carried out as an outpatient procedure.

 

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