Fat absorption studies in the diagnosis and treatment of pancreatic fibrosis.

The presence of steatorrhoea in pancreatic fibrosis was formerly the cause of its confusion with coeliac disease. This confusion was dispelled by the studies of Blackfan and Wolbach (1933) and of Andersen (1938) who clearly separated pancreatic fibrosis as a separate entity by showing that in this disease there was atrophy of the secretory tissue of the pancreas and that the steatorrhoea resulted from deficiency in pancreatic lipase. Andersen (1945) claimed that, although analysis of single stools or three-day stool collections generally revealed a great increase of faecal fat in pancreatic fibrosis, this was not always found. In the light of recent work, however (Kamer, Bokkel Huinink and Weyers, 1949), it would appear that fat balance studies are necessary for a reliable assessment of fat absorption. In the treatment of pancreatic fibrosis Andersen (1949) stressed the importance of maintaining satisfactory nutrition and claimed that the respiratory involvement, which is such a common feature of this disease, might be secondary to impaired absorption of some substance essential for the normal functioning of the bronchi. The value of pancreatin in improving absorption of food substances in pancreatic fibrosis has been studied by various workers. Shohl, May and Shwachman (1943) found that although pancreatin resulted in a reduction of faecal nitrogen there was no significant decrease in faecal fat, whereas Andersen (1945) using a pancreatin preparation of higher lipase content than that employed by Shohl et al. showed that it produced a considerable decrease in faecal fat. May and Lowe (1949), however, have questioned the usefulness of pancreatin in the treatment of this disease. The object of the present study was to ascertain the magnitude of the fat absorption defect in pancreatic fibrosis by means of fat-balance studies and chylomicrographs, and to compare the findings with those obtained in coeliac disease. From the fat absorption findings in pancreatic fibrosis an attempt was made to estimate the value of pancreatin in treatment and to place dosage on a rational basis.