Fecal Elastase-1 as a Test for Pancreatic Function: a Review

Abstract

Pancreatic elastase-1 is a specific human protease synthetized by the acinar cells. Immunoreactive elastase-1 cannot be detected in either porcine or bovine pancreatic enzyme preparations. It is very stable and, in contrast to fecal chymotrypsin, elastase is unaffected by exogenous pancreatic enzyme treatment, and correlates well with exocrine pancreatic function tests. The measurement of this proteolytic enzyme in stool by means of an enzyme-linked immunosorbent assay (ELISA) is a sensitive, specific, and relatively inexpensive non-invasive test. It is an accurate function test for patients with chronic pancreatitis confirmed by endoscopic retrograde cholangiopancreatography and computerized axial tomography. It shows higher sensitivity and specificity for exocrine pancreatic insufficiency than fecal chymotrypsin determination and is comparable to oral pancreatic function tests such as the pancreolauryl test.

Interpretations: How to use faecal elastase testing

“…Results are reported as microgram per gram of stool. The lower detection limit is 15 μg/g 17. The cost of analysis is approximately £26, and turnaround time is approximately 21 days.…”

Fecal elastase-1: Utility in pancreatic function in cystic fibrosis

“…They found that, using a < 200 Ag/g cut-off, the test had an overall 93% sensitivity and 93% specificity. Limits of analytical sensitivity are not well defined, but a detection limit of 15 Ag/g is generally reported [12]. Soldan et al compared 16 CF patients with established pancreatic insufficiency by the secretin -pancreozymin test to 23 healthy controls and found that, using the standard cut-off of 200 Ag/g of stool for E1, they had a 96% specificity and 100% sensitivity for detection of pancreatic insufficiency [13].…”

“…Thus, E1 appears to have some advantages over fecal chymotrypsin in detection of pancreatic insufficiency in that it has comparable if not better sensitivity, depending on the cut-off values used. E1 is very stable in stool samples and can be estimated even in patients on pancreatic enzyme supplements without need for their discontinuation [12].…”

Prevalence of Pancreatic Insufficiency in Inflammatory Bowel Diseases. Assessment by Fecal Elastase-1

“…Evaluation of human pancreatic fecal elastase-1 (FE-1) in the stool is currently the most reliable and sensitive non-invasive procedure for the diagnosis of PI, with a sensitivity ranging from 54 to 95% and a specificity of approximately 80% [7][8][9][10][11]. A commercial enzyme-linked immuno-sorbent assay (ELISA) method is currently available to measure FE-1 concentration in stool samples, thus providing the potential for a simple, reliable, and noninvasive evaluation of pancreatic function in IBD patients [10].…”