DUODENAL SECRETION OF PHOSPHOLIPASE A(2), AMYLASE, AND BICARBONATE INCHRONIC-PANCREATITIS

Phospholipase A(2) has been suggested to be involved hi the pathogenes is and pathophysiology of acute pancreatitis, We determined phospholip ase Al and amylase activities in duodenal juice collected during a sec retin test from 30 consecutive patients who were suspected to have chr onic pancreatitis or biliary disease. The patients underwent endoscopi c retrograde cholangiopancreatography (ERCP) the following day, In the 8 patients with ERCP findings of advanced chronic pancreatitis, the m ean outputs of phospholipase A(2), amylase, and bicarbonate were reduc ed by 74%, 72%, and 60% compared to the respective values in the 13 (c ontrol) patients without a diagnosis of any pancreatic disorder or jau ndice, In the 3 patients with recurrent pancreatitis but normal ERCP f indings and in the 6 patients with jaundice the output values were not significantly reduced compared to those in the patients without any p ancreatic disorder or jaundice. The outputs of amylase and phospholipa se A(2) were not significantly interrelated, whereas the outputs of ph ospholipase A(2) and bicarbonate correlated well. Receiver characteris tic (ROC) curves confirmed the high specificity and sensitivity of pho spholipase A(2) or bicarbonate output in patients with ERCP findings o f advanced chronic pancreatitis compared to those with no changes in p ancreatic ducts, with similar probability values of 0.880 +/- 0.111 (S EM), compared to the respective lower value of amylase, 0.676 +/- 0.11 8, Phospholipase A(2) and bicarbonate output proved of equal value as markers of chronic pancreatitis and were superior to amylase output in the secretin test.