The
bentiromide test was evaluated using plasma
p-aminobenzoic acid as an indirect test of
pancreatic insufficiency in young children between 2 months and 4 years of age. To determine the optimal test method, the following were examined: (a) the best dose of
bentiromide (15 mg/kg or 30 mg/kg); (b) the optimal sampling time for plasma
p-aminobenzoic acid; and (c) the effect of coadministration of a liquid meal. Sixty-nine children 91.6 +/- 1.0 years) were studied, including 34 controls with normal fat absorption and 35 patients (34 with
cystic fibrosis) with fat maldigestion due to
pancreatic insufficiency. Control and pancreatic insufficient subjects were studied in three age-matched groups: (a) low-dose
bentiromide (15 mg/kg) with clear fluids; (b) high-dose
bentiromide (30 mg/kg) with clear fluids; and (c) high-dose
bentiromide with a liquid meal. Plasma
p-aminobenzoic acid was determined at 0, 30, 60, and 90 minutes then hourly for 6 hours. The dose effect of
bentiromide with clear liquids was evaluated. High-dose
bentiromide best discriminated control and pancreatic insufficient subjects, due to a higher peak plasma
p-aminobenzoic acid level in controls, but poor sensitivity and specificity remained. High-dose
bentiromide with a liquid meal produced a delayed increase in plasma
p-aminobenzoic acid in the control subjects probably caused by retarded gastric emptying. However, in the pancreatic insufficient subjects, use of a liquid meal resulted in significantly lower plasma
p-aminobenzoic acid levels at all time points; plasma
p-aminobenzoic acid at 2 and 3 hours completely discriminated between control and pancreatic insufficient patients. Evaluation of the data by area under the time-concentration curve failed to improve test results. In conclusion, the
bentiromide test is a simple, clinically useful means of detecting
pancreatic insufficiency in young children, but a higher dose administered with a liquid meal is recommended.