Diagnosis of lipid malabsorption in patients with chronic pancreatitis: A new indirect test using postprandial plasma apolipoprotein B-48

OBJECTIVE: This study was done to evaluate a new test for fat malabsorption caused by chronic pancreatitis. Postprandial plasma apolipoprotein B-48 wa s measured as an indicator of the intestinal assimilation of exogenous lipi d. METHODS: Twenty-three patients with chronic pancreatitis, including 19 insu lin-treated diabetic patients, were compared with 14 healthy subjects and s even type-1 diabetic patients. Each was given a test meal containing 40 g l ipid; the triglyceride apolipoprotein B-48 concentrations in chylomicrons w ere determined 240 min later. RESULTS: The postprandial chylomicron apolipoprotein B-48 concentrations in the three groups were statistically different at 240 min: pancreatitis ver sus controls, p < 0.01, and pancreatitis versus type-1 diabetes subjects, p < 0.01. The Delta plasma apo B-48, the change in apolipoprotein B-48 betwe en 0 and 240 min, was significantly smaller in chronic pancreatitis patient s than in controls (p < 0.001) and type-1 diabetes subjects (p < 0.001). Th e sensitivity of the test was better than 89% for a Delta apo B-48 threshol d value of 0.42 mg/dl. CONCLUSIONS: This new indirect test is relatively simple to use and could b e practical for evaluating exogenous lipid malabsorption due to chronic pan creatitis. (C) 1999 by Am. Coil. of Gastroenterology.