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.
