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Best evidence topic report
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

    https://doi.org/10.1136/emj.17.5.366-a

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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.

      View this table:
      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

      1. Kemppainen EA, Hedstrom JI, Puolakkainen PA, et al. Rapid measurement of urinary trypsinogen-2 as a screen-ing test for acute pancreatitis. N Engl J Med1997;336:1788–93.
        OpenUrlCrossRefPubMedWeb of Science
      2. Tenner S, Fernandez-del Castillo C, Warshaw A, et al. Urinary trypsinogen activation peptide (TAP) predicts severity in patients with acute pancreatitis. Int J Pancreatol1997;21:105–10.
        OpenUrlPubMedWeb of Science
      3. Kylanpaa-Back ML, Kemppainen E, Puolakkainen P, et al. Reliable screening for acute pencreatitis with rapid urine trypsinogen-2 test strip. Br J Surg2000;87:49–52.
        OpenUrlCrossRefPubMedWeb of Science