A prospective, comparative study of the para‐aminobenzoic acid test and faecal elastase 1 in the assessment of exocrine pancreatic function

Abstract

SUMMARYBackground: The assessment of exocrine pancreatic insufficiency is part of the routine work-up of patients with persistent diarrhoea or suspected steatorrhoea. Direct and indirect tests for the diagnosis of exocrine pancreatic insufficiency have their drawbacks. Measurement of faecal elastase 1 by enzyme-linked immunoabsorbent assay is a simple, non-invasive, robust test for exocrine pancreatic insufficiency. Methods: We performed a prospective comparison of the para-aminobenzoic acid test and faecal elastase 1 test in 45 patients being investigated for diarrhoea or suspected steatorrhoea. Details of clinical suspicion, imaging and response to treatment were recorded. Results: Exocrine pancreatic function was normal in 20 patients with normal para-aminobenzoic acid and faecal elastase 1 levels. Eight patients had exocrine pancreatic

Fecal Elastase: A Useful Test for Pancreatic Insufficiency?

“…FE-1 is well documented in quantitative studies to be stable during intestinal transit and studies demonstrate significant correlation between fecal elastase and levels of other pancreatic enzymes such as duodenal lipase, amylase, trypsin, and bicarbonate concentration [2][3][4][5][6]. Fecal elastase is concentrated in human feces compared with pancreatic juice and is a simple, non-invasive and inexpensive test [2,7,8]. As a result, FE-1 has replaced ''tube tests'' and fecal fat measurement in most centers and has become the sole arbiter of pancreatic insufficiency for many.…”

“…Pancreatic disease is diagnosed on a combination of clinical history, abnormal pancreatic function tests, and radiological criteria [8]. Although subtle changes in exocrine function can be identified in patients with early pancreatic disease, overt steatorrhea does not occur until approximately 90% of the glandular function has been lost [9].…”

“…Although subtle changes in exocrine function can be identified in patients with early pancreatic disease, overt steatorrhea does not occur until approximately 90% of the glandular function has been lost [9]. Direct function tests such as the secretin-cholecystokinin have the highest sensitivity and specificity and are the 'gold standard' [8]. They are, however, expensive, invasive, and time-consuming.…”

Comparing the urinary pancreolauryl ratio and faecal elastase-1 as indicators of pancreatic insufficiency in clinical practice

“…Glasbrenner et al [26] concluded that the FE-1 is comparable to the standard serum PLT in the diagnosis of pancreatic insuffi ciency. A recent comparative study by Sonwalkar et al [27] has concluded that the FE-1 has a superior diagnostic performance to the NBT-PABA test. The NBT-PABA and PLT have similar sensitivity and specifi city when compared to invasive tube tests [2] , but the NBT-PABA is now rarely used in the UK as pharmaceutical grade reagents are not available.…”

Delayed release pancrelipase for treatment of pancreatic exocrine insufficiency associated with chronic pancreatitis

“…Various other clinical (Body weight, nutritional status, frequency of bowel movements, stool character, abdominal pain, global disease symptom score, quality of life score) as well as laboratory indicators (fecal elastase, fecal chymotrypsin, etc) may be used to test adequacy of PES in various studies. Of the laboratory tests, fecal elastase is a useful non-invasive test for detection of PEI, [110][111][112] but its usefulness in evaluating treatment compliance with PES has not been described.…”