• Jaroslaw Walkowiak, Sanda Nousia-Arvanitakis, Aleksandra Lisowska, Robert Piotrowski, Krystyna Strzykala, Bartosz Bychowiec, Tomasz Songin, Assimina Galli-Tsinopoulou, Dorota Sands, Ifigenia Pidonia, Marian Krawczynski, Andrzej Milanowski, and Karl-Heinz Herzig.
• Department of Gastroenterology, Institute of Pediatrics, Karol Marcinkowski University of Medical Sciences, Poznan, Poland. jarwalk@am.poznan.pl
• J. Pediatr. Gastroenterol. Nutr. 2004 Apr 1; 38 (4): 430-5.

BackgroundThe assessment of severe pancreatic insufficiency in cystic fibrosis (CF) is not a diagnostic problem. However, identification of mild cases remains a challenge. The aim of this study was to assess the ability of serum lipase after secretin stimulation to identify mild pancreatic insufficiency in patients with CF.Material And MethodsThirty patients with CF and pancreatic insufficiency (CF-PI) and 30 patients with CF and pancreatic sufficiency (CF-PS) were studied. Thirty healthy subjects with no known gastrointestinal disease served as controls. In all subjects, fecal fat excretion, fecal elastase-1 (E1) concentration and basal and secretin-stimulated serum lipase concentration were measured.ResultsAll patients with CF-PI and 3 with CF-PS had abnormally low fecal E1 concentrations. The remaining 27 CF-PS patients and all controls had normal values. Basal and post-stimulation lipase levels were extremely low in patients with CF-PI. Mean basal and poststimulation serum lipase concentrations were significantly higher in CF-PS who had normal fecal E1 concentrations but were still below those of controls (P < 0.001). Among the 27 CF-PS patients with normal fecal elastase, high basal and poststimulation lipase values were found in 6 and 17 patients respectively.ConclusionIn patients with CF-PS who have normal fecal elastase-1 concentration, the measurement of basal or secretin-stimulated lipase levels might be helpful in identifying the progression of the destructive process in the pancreas.

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