Pancreatic digestive function after subtotal gastrectomy--evaluation by an indirect method.

Digestive function of 24 patients with Billroth (BII) subtotal gastrectomy and gastrojejunostomy was investigated using an oral pancreatic function test with fluorescein-dilaurate as substrate (FDL-test). The FDL-test after Bll subtotal gastrectomy revealed maldigestion in 75% of the patients. The mean FDL-ratio (normal when higher than 30%) was 21.6 +/- 4.9% in Bll patients, compared with 62.2 +/- 6.9% in healthy controls (p less than 0.001). No correlation between such digestive complaints as dumping and diarrhoea and the FDL-test results was found. Although FDL-test results were abnormal in all patients with chronic pancreatitis, they were also found to be abnormal in 8 patients who did not have chronic pancreatitis. Consequently, the FDL-test cannot be used as a specific test for chronic pancreatitis after gastric operations. Since free fluorescein is normally absorbed after gastric resection, an abnormal FDL-test result indicates impaired pancreatic digestion, possibly due to delayed enzyme and/or poor intraluminal mixing.