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[Changes in the serum pancreas enzyme following i.v. stimulation with secretin in subjects with a normal pancreas].

The diagnostic value of serum enzyme provocative tests (SEP) is disputed. In particular, the specificity of the test has not been adequately investigated. New interest in the test has arisen with the introduction of pancreas-specific serum enzyme tests. It has been shown that a poststimulatory increase of serum enzymes is found in chronic pancreatitis with well preserved exocrine function, but also in healthy individuals and particularly cigarette smokers. Recently it has been postulated that the lack of a poststimulatory enzyme response is typical of advanced chronic pancreatitis. We investigated the effect of secretin (1 CU/kg i.v.) on serum levels of amylase, pancreasisoamylase, lipase and trypsin for 30 minutes in 48 volunteers without pancreatic disease (19 non-smokers, 19 smokers and 10 patients with hypoxemia). Mean values of all enzymes were significantly higher after stimulation. Enzyme response of trypsin and lipase was more pronounced than that of amylase or pancreasisoamylase. However, depending on the enzyme studied, no significant increase of serum values was found in 47.4% to 89.5% of smokers, 26.3 to 68.4% of non-smokers and 10 to 50% of patients with hypoxemia. The marked variability of enzyme response in controls demonstrates the low specificity of this test. Therefore, SEP are of no diagnostic value in pancreatic disease.