Variability of fecal pancreatic elastase measurements in cystic fibrosis patients

Meyts, Isabelle; Wuyts, Wim; Proesmans, M.; Boeck, K. De

doi:10.1016/s1569-1993(02)00097-8

Cited by 21 publications

(14 citation statements)

References 8 publications

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“…In addition, variability is obvious with repeat measurements for some patients. 25 In the current PI cohort, 5 of 8 patients had elastase levels below the more stringent cutoff value of 100 g/g stool. For the other one half of the patients with PI in the cohort, the pancreatic status was determined on the basis of the 3-day fecal fat balance.…”

Section: Discussionmentioning

confidence: 77%

Pancreatitis Among Patients With Cystic Fibrosis: Correlation With Pancreatic Status and Genotype

Boeck¹,

Weren²,

Proesmans³

et al. 2005

Pediatrics

132

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ABSTRACT. Objective. Pancreatitis is an infrequent complication among patients with cystic fibrosis (CF). It has mainly been reported for patients with pancreatic sufficiency (PS). Previous studies involved only a small number of patients because they contained data from single centers. The aim of this study was to evaluate the incidence of pancreatitis in a large heterogeneous CF population, to determine the relationship with pancreatic function, and to assess whether pancreatitis is associated with specific CFTR mutations.Methods. Physicians caring for patients with CF were approached through the CF Thematic Network or through the European Cystic Fibrosis Foundation newsletter. They were asked to provide data on their current patient cohort through a standardized questionnaire and to report how many patients they had ever diagnosed as having pancreatitis. A detailed questionnaire was then sent, to be filled out for all of their patients for whom pancreatitis had ever occurred. We defined pancreatitis as an episode of acute abdominal pain associated with serum amylase levels elevated above the ranges established by each participating center's laboratory. General clinical data included age, genotype, age at diagnosis of CF, sweat chloride concentrations, pancreatic status, biometric findings, and respiratory status. CFTR mutations were also reported according to the functional classification of classes I to V. Patients were categorized as having PS, pancreatic insufficiency (PI), or PI after an initial period of PS. PI was defined as a 72-hour stool fat loss of >7 g/day, fat absorption of <93%, or fecal elastase levels of <200 g/g feces. Clinical data on pancreatitis included age at the first episode, amylase and lipase levels, possible triggers, and occurrence of relapses or complications.Results years).Conclusions. This study of 10 071 patients with CF from 29 different countries revealed an estimated overall occurrence of pancreatitis among patients with CF of 1.24% (95% CI: 1.02-1.46%). The incidence of pancreatitis was much higher among patients with PS. However, pancreatitis was also reported for 15 patients with PI from 11 centers in 9 different countries. A correct diagnosis of pancreatitis for the reported patients with PI was supported by amylase and lipase levels increased above 500 IU/L, similar to those for patients with PS and pancreatitis. A correct diagnosis of PI for these patients with pancreatitis was supported by the adequacy of the methods used. We chose the cutoff values used to distinguish between patients with PI and control subjects without gastrointestinal disease. For one half of the patients, the diagnosis of PI was established on the basis of low levels of stool elastase (mean: 97 g/g stool). With a cutoff value of 200 g/g stool, this noninvasive test has high sensitivity (>95%) and high specificity (>90%) to differentiate patients with PI from control subjects with normal pan- creatic function. For the other one half of the patients with PI in the cohort, the pancreatic status was ...

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Section: Discussionmentioning

confidence: 77%

Pancreatitis Among Patients With Cystic Fibrosis: Correlation With Pancreatic Status and Genotype

Boeck¹,

Weren²,

Proesmans³

et al. 2005

Pediatrics

132

View full text Add to dashboard Cite

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“…Pancreatic status was determined by fat or elastase contents in stool samples: patients currently not treated by pancreatic enzyme replacement with fecal fat Ͻ7% (wt/wt) of the amount of dietary fat or with fecal elastase Ͼ200 g/g were defined as pancreatic sufficient (15,16 ), the others as pancreatic insufficient. Respiratory involvement was assessed by lung function testing.…”

Section: Study Participantsmentioning

confidence: 99%

Influence of Pancreatic Status and Sex on Polyunsaturated Fatty Acid Profiles in Cystic Fibrosis

Coste¹,

Deumer²,

Reychler

et al. 2008

Clinical Chemistry

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Background: Some but not all studies have reported abnormal polyunsaturated fatty acid composition in cystic fibrosis (CF) patients. We investigated the influence of pancreatic status and sex on the fatty acid profile in plasma and erythrocyte membranes in patients with CF. Methods: After a 1-step transesterification with acetyl chloride on plasma and washed erythrocyte membranes, we quantified fatty acid methyl esters by use of GC-MS in 124 CF patients and 80 age-matched healthy controls. In the CF group, mean (SD) age was 17.5 (11.3) years, and 51.6% were male. Pancreatic insufficiency was diagnosed in 78% of the CF population. Results: A decrease in docosahexaenoic acid concentrations was observed in CF patients independently of pancreatic status. Pancreatic insufficient CF patients displayed lower concentrations of linoleic acid and arachidonic acid and higher concentrations of dihomo-γ-linolenic acid and eicosatrienoic acid (mead acid) in plasma and erythrocyte membranes compared with healthy controls and pancreatic sufficient CF patients. Male CF patients had significantly lower docosahexaenoic acid and higher eicosatrienoic acid in plasma and erythrocyte membranes compared with female CF patients. Conclusions: These results support the concept that multiple abnormalities of polyunsaturated fatty acid composition participate in the CF disease phenotype and that pancreatic status plays a major role in such abnormalities. Moreover, patient sex influences the polyunsaturated fatty acid spectrum in CF, with more marked abnormalities in males.

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“…A variation of 6.64% between samples stored at À 25 -C and room temperature was noted and 2.51% for samples stored at 4 -C and room temperature. To determine test variability in CF patients, Meyts et al recruited 26 patients [17]. Based on symptoms and a 72-h fecal fat estimation, 19 patients were determined to be pancreatic insufficient.…”

Section: Test Variabilitymentioning

confidence: 99%

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

Daftary

Acton

Heubi

et al. 2006

Journal of Cystic Fibrosis

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Early detection and management of pancreatic insufficiency is essential to optimize health and outcomes in cystic fibrosis patients. The gold standard measures for assessment of pancreatic function are direct pancreatic stimulation tests, which have numerous limitations. Estimation of fecal elastase-1 level to determine pancreatic function is an attractive alternative as the test is simple, rapid, cost-effective and easy to perform even in children. This review summarizes the data from studies reflecting the validity, limitation and advantages of fecal elastase-1 in assessing pancreatic function in cystic fibrosis patients.

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Variability of fecal pancreatic elastase measurements in cystic fibrosis patients

Abstract: the EL-1 test can be used for diagnosing severe PI in CF patients with overt clinical symptoms of malabsorption. However, in CF patients where the clinical picture is less clear the EL-1 test may be inconclusive due to significant intra-patient variability.

Cited by 21 publications

References 8 publications

Pancreatitis Among Patients With Cystic Fibrosis: Correlation With Pancreatic Status and Genotype

Pancreatitis Among Patients With Cystic Fibrosis: Correlation With Pancreatic Status and Genotype

Influence of Pancreatic Status and Sex on Polyunsaturated Fatty Acid Profiles in Cystic Fibrosis

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

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