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Urinary trypsinogen to rule out acute pancreatitis in patients with abdominal pain
  1. John Butler,
  2. Magnus Harrison
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by John Butler, Specialist Registrar Search checked by Magnus Harrison, Research Fellow

    Clinical scenario

    A 45 year old woman attends the emergency department with a four hour history of acute epigastric pain. She has a history of alcohol use. Examination reveals epigastric tenderness but no peritonism. You consider pancreatitis and wonder whether a single urinary trypsinogen measurement can be used to rule out this diagnosis.

    Three part question

    In [patients with abdominal pain and a suspicion of pancreatitis] can [a urinary trypsinogen test] [rule out pancreatitis]?

    Search strategy

    Medline 1966–06/00 using the OVID interface. ({exp abdominal pain OR abdominal pain.mp OR exp pancreatitis OR exp pancreatitis, acute necrotising OR exp pancreatitis, alcoholic OR pancreatitis.mp} AND exp trypsin OR exp trypsinogen OR trypsin$.mp OR trypsinogen$.mp}) AND sensitivity.tw LIMIT to human AND english.

    Search outcome

    Altogether 74 papers found of which 71 were irrelevant or of insufficient quality for inclusion. The remaining three papers are shown in table 4.

    Table 4

    Comments

    The sensitivity of urinary trypsinogen is around 95%. Its clinical efficacy is much higher than the tests that are commonly used.

    Clinical bottom line

    Urinary trypsinogen can be used as a sensitive tool to exclude pancreatitis in emergency departments.

    Report by John Butler, Specialist Registrar Search checked by Magnus Harrison, Research Fellow

    References

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