Article

Uncommon Test Helps Confirm Chronic Pancreatitis Diagnosis

Duke one of few centers to offer endoscopic pancreatic function testing

Finger pointing to a binder with a label that says pancreatitis

Chronic pancreatitis can mimic peptic ulcer disease, gastritis, and other gastrointestinal conditions, making it difficult to diagnose. However, an endoscopic pancreatic function test that Duke is one of only a few medical centers in the country to offer can help to better identify the indolent inflammatory condition.

Darshan Kothari, MD, a gastroenterologist who specializes in pancreatic disorders, says patients often suffer from either recurrent or persistent abdominal pain without a clear diagnosis. “It’s common for patients to initially be given the wrong diagnosis or a catch-all diagnosis, such as functional abdominal pain. Conversely, patients can also be given an incorrect diagnosis of chronic pancreatitis when in fact they do not have it,” he explains.

Typically, the inflammatory condition is diagnosed when patients present with abdominal pain and have some form of imaging. However, even after a CT scan, MRI, and endoscopic ultrasound, the findings may not confirm a diagnosis.

How the test works

The most sensitive test for the diagnosis of chronic pancreatitis is the secretin pancreatic function test. Traditionally, patients undergo an upper endoscopy in which a tube is placed into the duodenum. After receiving an intravenous form of the hormone secretin, patients recover for an hour with a tube in their mouth. During this hour, the fluid secreted from the pancreas into the small intestine is aspirated and analyzed to determine what concentration of bicarbonate the pancreas is producing. Kothari explains that if the peak bicarbonate is below the 80 mEq threshold, it indicates a diagnosis of chronic pancreatitis; importantly, though, a normal test has a 97% negative predicted value, virtually ruling out chronic pancreatitis.

“While many centers choose to use endoscopic ultrasound as a means of diagnosing chronic pancreatitis, the benefit we provide our patients at Duke is that even for those patients in whom those findings are indeterminate but the suspicion remains high, this pancreatic function testing provides those patients some comfort to confirm or rule out a diagnosis based on their symptoms,” Kothari says.

Why the test is important

“Patients come to Duke wanting to know a diagnosis, and with this test, we’re able to give them a relatively dichotomized answer,” Kothari says. For the 15 in 100,000 people who develop chronic pancreatitis, “It’s important to have a diagnosis because it helps patients deal with this disease in a more positive way,” he adds. “It’s also important because we are able to administer therapy that they may not otherwise have received without this diagnosis due to insurance coverage.”

Kothari adds that while treatment for a patient’s symptoms may not differ based on the results of an endoscopic ultrasound versus the endoscopic pancreatic function testing, “it helps us properly advise our patients on what to do next. There is a real risk—albeit small—for pancreatic cancer in patients who have chronic pancreatitis, and we have to keep an eye on that risk for these patients.”