CLINICAL EVALUATION OF ABNORMAL ENZYME CONTENT IN THE PANCREATIC JUICE OF CHILDREN

Abstract

One hundred and sixty-five children were intubated and the enzyme activity of their duodenal juice studied. Seventy-six patients showed normal potency of all the pancreatic enzymes and had clinical conditions apparently unrelated to pancreatic secretions. The other 89 patients were included in this study and grouped as follows: Group I: Twenty-three children had minimal pancreatic enzyme activity and presumably were suffering from fibrocystic disease of the pancreas. Group II: Two children with minimal enzyme activity may have had a pancreatic deficiency of different etiology from that of Group I. Group III: Four children had transitory partial suppression of trypsin, lipase and amylase. In three, after recovery, repeated studies showed that their enzymes were normal. The fourth child died without the enzyme studies having been repeated. A fifth child had complete suppression of enzyme activity while ill with a respiratory infection. She is included in this group because, coincident with her clinical recovery, there was an appreciable return of enzyme activity. Clinically, these five children had nothing in common. Group IV (a): Twenty-five children had suppression of lipase activity in conjunction with a normal level for trypsin and amylase. Most of them had some type of gastrointestinal disturbance. Four had diseases of the respiratory system. Sixteen of these children were restudied. The return of lipase activity coincided roughly with a return to health: those who were studied at a time they were clinically well had normal enzyme activity, while those who were not well still had a reduced secretion of pancreatic lipase. None proved to be early cases of progressive pancreatic deficiency. Group IV (b): There were no children with deficient trypsin activity in the presence of normal lipase and amylase. Group IV (c): Sixteen children were deficient in amylolytic activity in conjunction with normal trypsin and lipase. Most of these children had gastrointestinal symptoms. Six of them had celiac disease. Group V: Eighteen children with extreme malnutrition had normal enzyme activity.