Function Tests & Pain Management: Pancreatic Disease
With Dr. Andrew Trout · hosted by Dr. Todd Ponsky · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Chronic Pancreatitis, Function Tests, & Pain Management: Pancreatic Disease
51 min · Published Sep 2016
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Chronic Pancreatitis - Pancreatic Pathologies by Cincinnati Children's Pancreas Care Center
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Overview of the Surgical Management of Acute and Chronic Pancreatitis in Children with Dr. Juan Gurria
66 min · Published Apr 2026
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Acute Pancreatitis
45 min · Published Jul 2017
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What the experts said
Direct pancreatic function testing means obtaining function directly from the pancreas, not relying on stool testing for fecal elastase.
Endoscopic pancreatic function testing replaced the duodenal-tube (drilling) method by the end of the 1990s/early 2000s.
Dr. Conwell and colleagues at Tyler Stevens launched endoscopic function testing, showing comparable results to duodenal-tube testing for bicarbonate and lipase measurement.
Endoscopic collection became the standard because duodenal-tube testing requires the patient to be awake, placement of two tubes, and interventional radiology.
The Cincinnati protocol uses secretin 0.2 mcg/kg or CCK 0.04 mcg/kg at time zero, then collects duodenal aspirates every 5 minutes for three samples using an ERCP tapered catheter.
The lab at Cincinnati Children's Hospital measures activities for four enzymes: trypsin, amylase, lipase, and chemotrypsin.
Pancreatic function can be abnormal if checked around an acute attack.
Exocrine pancreatic maturation occurs over the first 2 to 3 years of life.
MR pancreatic function testing acquires identical imaging pre- and post-secretin to quantify the volume of fluid secreted into the gastrointestinal tract.
The delay between pre- and post-secretin MR imaging is about 15 minutes to allow fluid accumulation.
MR-PFT can threshold images and quantify secreted fluid volume by subtracting pre-secretin from post-secretin fluid volume.
Phantom studies have proven that MR can accurately quantitate fluid volume.
Preliminary data in about 35 patients are examining correlation between MR-PFT and endoscopic pancreatic function testing.
Qualitative MR exocrine assessment appears different between pediatric and adult patients, suggesting possible size or weight dependency.
In chronic or acute recurrent pancreatitis patients with ductal changes, the pancreatic duct is often dilated and abnormal at baseline, so secretin may not be needed to visualize the duct.
Low-fat diet, pancreatic enzyme replacement therapy (PERT), antioxidants, and steroids have never been shown to prevent recurrent pancreatitis episodes or pancreatic pain episodes.
The case patient was PRSS1-positive on genetic testing.
The case patient had low fecal elastase on two occasions and endoscopic PFTs showed low amylase and lipase, borderline low trypsin and chemotrypsin.
The case patient had normal hemoglobin A1C and normal mixed meal test for endocrine function.
The case patient showed evidence of ductal changes on ERCP, confirming chronic pancreatitis based on imaging and ERCP findings.
The case patient has been pain-free on PERT treatment for several months with catch-up growth.
The multidisciplinary pain consult at Cincinnati comprises three disciplines: pain physician (medical/psychosocial assessment, medication, interventional management), psychologist (100% of the time, not optional), and nurses.
The 13-year-old pain case had extensive psychiatric disabilities: bipolar disorder, attention deficit disorder, oppositional defiant disorder.
The 13-year-old's recurrent pancreatitis episodes were timed almost specifically with visits to his father, when he went off all medical regimen (diet, enzyme therapy).
Cognitive-behavioral therapy is the standard, state-of-the-art therapy for pain management.
Topiramate was used for the 13-year-old's migraines and may have a role for visceral hyperalgesia where the gut has become sensitized by repeated inflammatory processes.
Low-dose methadone was used for about 2 years in the 13-year-old case, and weaning off was not a problem when the time was right.
In Ohio, informed consent is required for the use of opioids for chronic purposes in minors (law about a year old at time of recording).
The 13-year-old's pain resolved for a couple of years without any surgical or endoscopic intervention, came off all pain medications, returned to school, and surgery was deferred indefinitely.
Discussing the neurobiology and neuropsychology of pain with families—using anecdotes like the paper-cut example (opening a lottery ticket vs. a bad report card)—helps destigmatize psychology referral.