Proteases in the evaluation of pancreatic function and pancreatic disease

This paper reviews the role of pancreatic proteases (focusing upon trypsin, chymotrypsin and elastase) in the diagnosis and management of chronic panc reatic insufficiency (CPI), emphasizing advances over the last 5 years. Som e important novel aspects of these enzymes in acute pancreatitis are also d escribed, including their role in diagnosis and their interaction with chol ecystokinin in the pathogenesis of the disease. The recent interest in thes e enzymes as agents promoting the spread of cancer in animals and human sub jects is also described. A hierarchical approach has been taken to explore the advantages and limitations of tests in different source materials: seru m, feces, duodenal aspirate, and non-invasive pancreatic function tests. Th e practical usefulness of fecal elastase-l and of fecal chymotrypsin concen trations in diagnosis and management of CPI, respectively, is one of the ma jor lessons to be learned from analysis of the recent literature, and forms the principal message of this review. (C) 2000 Elsevier Science B.V. All r ights reserved.