Sensitivity and Specificity of Quantitative Determination of Pancreatic Elastase 1 in Feces of Children

Soldan, W.; Henker, J; Sprössig, C

doi:10.1097/00005176-199701000-00013

Cited by 82 publications

(54 citation statements)

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“…It is stable, unaffected by exogenous pancreatic enzyme treatment, and correlates well with stimulated pancreatic function tests. [27][28][29] There may be some transient mild pancreatic insufficiency associated with some reduction in EL1 levels in patients with celiac disease before treatment. This is not to the same degree as the pancreatic insufficiency associated with cystic fibrosis.…”

Section: Identification Of a Pancreatic Lesionmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

102

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Summary. Intestinal malabsorption is severe and of early onset in virtually all people who have cystic fibrosis. The main cause is deficiency of pancreatic enzymes. Bicarbonate deficiency, abnormal bile salts, mucosal transport problems, motility differences, and anatomical structural changes are other contributory factors. Effective treatment should allow a normal to high-fat diet to be taken, control symptoms, correct malabsorption, and achieve a normal nutritional state and growth. Appropriate pancreatic enzyme replacement therapy will achieve normal or near-normal absorption in most people with cystic fibrosis. Early identification and treatment of intestinal malabsorption is critical to achieving optimal nutritional status. The occurrence of fibrosing colonopathy in a few patients on very high doses of those enzymes which have the copolymer Eudragit L30 D55 in their covering resulted in guidelines in the UK to avoid doses equivalent to more than 10,000 IU lipase per kg per day, and also to avoid preparations containing this copolymer in children and adolescents. For patients not responding to 10,000 IU lipase per kg per day review of adherence to treatment, change of enzyme preparation, variation in time of administration, and reduction in gastric acid may improve absorption. The importance of early investigation to exclude other gastrointestinal disorders as a cause of the patient's symptoms, rather than merely increasing the dose of enzymes, is stressed. With modern pancreatic enzymes in doses up to or only slightly in excess of 10,000 IU lipase per kg per day, adequate control of gastrointestinal symptoms and absorption can be achieved, and a normal nutritional state and growth rate maintained in most people with cystic fibrosis.

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Section: Identification Of a Pancreatic Lesionmentioning

confidence: 99%

Diagnosis and Treatment of Intestinal Malabsorption in Cystic Fibrosis

Littlewood

Wolfe

Conway

2005

Pediatric Pulmonology

102

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“…6 -8 More recently, fecal E1 test has been demonstrated to have very good sensitivity in PI CF patients. 11,[25][26][27] Yet, in milder forms of CF pancreatic insufficiency, the sensitivity of the test was reduced. 24,27 Therefore, one could expect a higher sensitivity and specificity of fecal E1 test.…”

Section: Fecalmentioning

confidence: 99%

Fecal Elastase-1 Is Superior to Fecal Chymotrypsin in the Assessment of Pancreatic Involvement in Cystic Fibrosis

Walkowiak¹,

Herzig

Strzykała³

et al. 2002

Pediatrics

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ABSTRACT.Objective. Exocrine pancreatic function in patients with cystic fibrosis (CF) can be evaluated by direct and indirect tests. In pediatric patients, indirect tests are preferred because of their less invasive character, especially in CF patients with respiratory disease. Fecal tests are noninvasive and have been shown to have a high sensitivity and specificity. However, there is no comparative study in CF patients. Therefore, the aim of the present study was to compare the sensitivity and the specificity of the fecal elastase-1 (E1) test with the fecal chymotrypsin (ChT) test in a large cohort of CF patients and healthy subjects (HS).Design. One hundred twenty-three CF patients and 105 HS were evaluated. In all subjects, E1 concentration and ChT activity were measured. In the CF group, fecal fat excretion was also determined. The sensitivity and specificity of the fecal E1 test and ChT test were compared.Results. With a cutoff level of 3 U/g, ChT specificity in HS was similar to that of E1, but E1 sensitivity in CF patients was significantly higher (90.2% vs 81.3%). With a cutoff level of 6 U/g, ChT and E1 sensitivity in CF patients was identical, but E1 specificity in HS was again significantly higher (98.1% vs 90.5%). In all CF patients with severe steatorrhea (>15 g/d), E1 concentrations were abnormal and ChT activity was lower than 3 U/g. In contrast, in pancreatic-sufficient patients and patients with mild steatorrhea (<15 g/d), the E1 sensitivity was significantly higher compared with ChT (69.2% vs 41.0%).Conclusions. The fecal E1 test is superior to fecal ChT determination in the assessment of CF pancreatic involvement in pancreatic-sufficient patients and those patients with mild steatorrhea. Pediatrics 2002;110(1). URL: http://www.pediatrics.org/cgi/content/full/110/1/e7; fecal elastase-1, fecal chymotrypsin, exocrine pancreatic function, cystic fibrosis.

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“…Previous studies reported a satisfying sensitivity around 100% for severe EPI [8][9][10]15] . However, its sensitivity in detecting mild forms of EPI was only 22-65% [9,15,16] .…”

Section: Discussionmentioning

confidence: 99%

“…Measurement of fecal elastase 1 (FE1) concentration is relatively simple and noninvasive. It has been reported to be a sensitive screening test for severe EPI [8][9][10] . In addition, the adult reference value for FE1 of greater than 200 g/g feces can be applied to infants older than 2 weeks [11] .…”

Section: Introductionmentioning

confidence: 99%