Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test

Abstract

The early diagnosis of pancreatic exocrine insufficiency (PEI) is hindered because many of the functional diagnostic techniques used are expensive and require specialized facilities, which prevent their widespread availability. We have reviewed current evidence in order to compare the utility of these functional diagnostic techniques with the fecal elastase-1 (FE-1) test in the following three scenarios: screening for PEI in patients presenting with symptoms suggestive of pancreatic disease, such as abdominal pain or diarrhea; determining the presence of PEI in patients with an established diagnosis of pancreatic disease, such as chronic pancreatitis or cystic fibrosis; determining exocrine status in disorders not commonly tested for PEI, but which have a known association with this disorder. Evidence suggests the FE-1 test is reliable for the evaluation of pancreatic function in many pancreatic and non-pancreatic disorders. It is non-invasive, is less time-consuming, and is unaffected by pancreatic enzyme replacement therapy. Although it cannot be considered the gold-standard method for the functional diagnosis of PEI, the advantages of the FE-1 test make it a very appropriate test for screening patients who may be at risk of this disorder.

The ageing pancreas: a systematic review of the evidence and analysis of the consequences

“…Although a number of authors relied on the faecal elastase-1 test when assessing the pancreatic function, some point at its limited sensitivity, especially in patients with mild pancreatic insufficiency, where the faecal elastase might be falsely low [143]. Nevertheless, it can be recommended as a screening test [144]. In the absence of other causes for fat malabsorption, a 3-day faecal fat estimation to detect steatorrhea could be a reasonable alternative.…”

Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review

“…Fecal elastase-1 (FE-1) test measures fecal levels of elastase-1, a proteolytic enzyme produced by pancreatic acinar cells. Fecal level of elastase-1 correlates with the output of other pancreatic enzymes, it is highly stable in feces and easy to meaure [16]. FE-1 demonstrated good sensitivity and specificity in moderate and severe PEI [17,18].…”

Practical guide to the management of chronic pancreatitis

“…FEL-1 has recurrently shown high sensitivity in severe PEI (85%–100%) but more varied results in moderate (35%–100%) and mild (25%–67%) disease with most studies showing a specificity >93% 41 42. It is felt to be the most appropriate first line investigation for screening for PEI in at risk patients 42. False positive FEL-1 samples can occur with water contamination form stool specimen collection, therefore strict instruction or low threshold for repeating should be considered with FEL-1 testing.…”