Prostaglandin E2 in jejunal fluids and its potential diagnostic value for selecting patients with indomethacin‐sensitive diarrhoea

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Abstract
Since prostaglandins (PG) appear to be important in the pathogenesis of secretory diarrhea, a radioimmunoassay for determination f PGE2 was applied to purified samples of jejunal fluids aspirated at the ligament of Treitz. Studies on validation of the assay system included quantification of PGE2 following alkali-treatment of the samples, variation of sample volume and fractionation of immunoreactive and tracer PGE2. The specificity of the assay system was confirmed by gas chromatography-mass spectrometry. In healthy volunteers (n = 22) the PGE2 concentration range was 5-205 pg/ml (99% confidence limits). Alcohol addicts (n = 27) with diarrhea or steatorrhea had PGE2 levels within the normal range. Values beyond the 99% upper confidence limit were observed in 10 of 17 patients with chronic diarrhea (205-340 pg/ml) and 2 of 15 patients with intermittent diarrhea (265 and 275 pg/ml) classified as irritable bowel syndrome. In 6 patients with high PGE2 concentrations indomethacin treatment (25 mg, 4 times daily) halved the associated diarrhea and reduced PGE2 concentrations to normal levels. A double-blind multiple randomized clinical trial was carried out in 2 single patients. Indomethacin was effective in preventing diarrhea only in the patient with a raised PGE2 level (P < 0.005).