Wert und Unwert klinisch-chemischer Stuhlanalysen

Abstract

The methods in use to establish diagnosis of intestinal disorders could be improved. Some of these can be applied by the pediatrician without difficulties: measuring of the stool-pH using an universal indicator stripe, the Kerry test for reducing substances. Until today there is no agreement on the most satisfactory test to detect occult blood in stool. The Guajac resign tests are differently sensitiv. Some produce a high number of false positive, but some also false negative results. A highly specific sensitive method in the diagnostic of exocrine pancreatic insufficiency is the measurement of chymotrypsin in an little portion of stool. This enzyme activity in stool is stabil for several days. The measurement is not disturbed by bacterial proteolytic activity of different bacteria. Fat is measured by the method of Van de Kamer; a three day faecal collection is necessary. The daily excretion of total fatty acids in stool is dependent on the age. Infants have higher normal values than older children. There is no correlation between stool weight and faecal fat. The diagnosis of gastrointestinal protein loss may be required by random faecal alpha-1-antitrypsin concentration as an endogen marker. It could be shown that this is a simple and reliable index of loss of plasma proteins into the gastrointestinal tract. Meconium contains higher concentration of α-1-AT than stool. The cumbersome utilization of isotopically labelled intravenous administered Cr⁵¹-albumin is not more necessary. All these tests undoubtadly have an important place in the pediatric gastroenterology, they are simple and most of them highly specific.

Zusammenfassung

Unter den vielen möglichen klinisch-chemischen Stuhlanalysen in Klinik und Praxis werden einige beschrieben, die auch der in der Praxis tätige Kinderarzt ohne größeren Zeit- und Materialaufwand vornehmen kann. Es sind dies die Stuhl-pH-Messung sowie der Kerry-Test auf reduzierende Substanzen, die Untersuchung auf okkultes Blut mit einem Guajak-Test sowie die Veranlassung von Stuhlfettbestimmungen nach Van de Kamer bzw. Chymotriypsin und α₁-Antitrypsin- Untersuchung im Stuhl bei entsprechendem klinischen Verdacht. Die Ergebnisse derartiger Untersuchungen können für den später behandelnden Arzt in der Klinik schon wertvolle Hinweise geben.