Obinna, Fiona Chioma Uchenna; (1995) Assessment of paediatric pancreatic and small bowel function using a combination of non-invasive in vivo tests. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Children commonly present to the clinician with diarrhoea and failure to thrive. The assessment of these patients can be problematic and diagnosis usually entails the performance of tedious and unpleasant invasive tests. For this reason non-invasive techniques for the evaluation of pancreatic and small bowel function offer an attractive alternative. This thesis investigates the use of combined non-invasive in vivo tests for the assessment of pancreatic and small bowel function. A total of 127 children were investigated. The median (interquartile range) age was 2.00 (1.00-5.25), years, range 0.17-17.25 years. The median (interquartile) weight was 10.00 (7.95-17.05)kg, range 1.51-58.80kg. Small intestinal transit time and permeability were determined by the lactulose breath hydrogen and lactulose:mannitol tests respectively. The bentiromide test was used to assess pancreatic chymotrypsin activity. For these tests subjects were given 0.5g/kg body weight lactulose (maximum 10g), 0.2g/kg body weight mannitol (maximum 4g), 15mg/kg body weight bentiromide (maximum 1g) and 4.5mg/kg p-amino salicylic acid (maximum 300mgs) administered in a single oral dose with 100mls water. Small bowel bacterial colonisation and fat malabsorption were evaluated by quantitation of urine methylmalonic acid and oxalate respectively. Samples were analysed by selected ion monitoring, gas chromatography-mass spectrometry and high performance liquid chromatography. 28.6[percent] of children with normal small bowel biopsies had abnormal non-invasive test results. Furthermore, in children with normal biopsies, a significant negative relationship was seen between urine recovery of the monosaccharide mannitol and urine excretion of oxalate (r = -0.564 p=0.008). In children with abnormal small bowel biopsies unexpected correlations were found between the urine excretion of methylmalonic acid and; pancreatic chymotrypsin activity (r= -0.584, p=0.022), urine excretion of oxalate (r= 0.542, p=0.011) and gut transit time (r= 0.907, p=0.013). These findings would suggest a role for combined, non-invasive assessment of gastrointestinal structure and function in the evaluation of children with unexplained diarrhoea and failure to thrive. Such findings may also have implications in follow-up assessment of children with chronic conditions.

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