The Lundh Test: A Review of its Clinical Use in the Diagnosis of Pancreatic Disease

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Abstract
The clinical value of the Lundh test in the diagnosis of pancreatic disorders was reviewed retrospectively in 139 patients with proven pancreatic disease (15 acute and 72 chronic pancreatitis, 51 pancreatic carcinoma and 1 partial pancreatectomy). There was a good separation between patients with pancreatic disease and those with other gastrointestinal disorders who presented with similar symptoms. The test was most helpful in patients with chronic pancreatitis (diagnostic rate 89%), more particularly in those presenting with jaundice or steatorrhea (100%) than pain (86%), but less successful (diagnostic rate 68%) in pancreatic carcinoma (steatorrhoea 100%; jaundice 64%; pain 55%). Complete absence of bile from duodenal juice in jaundiced patients usually indicated pancreatic or hepatobiliary carcinoma. Cytological examination of duodenal juice increased the usefulness of the test. Although malignant cells were rarely seen, characteristic (degenerate) cells were found in 22 of 44 (50%) patients with, but only 5 of 85 (6%) without pancreatic disease, even when the MTA (mean tryptic activity) was normal. The Lundh test can be conveniently combined with a jejunal biopsy at the same intubation for the investigation of diarrhea or steatorrhea.