Usefulness of faecal elastase-1 assay in monitoring pancreatic function in childhood coeliac disease.
BACKGROUND
In coeliac disease it has been demonstrated that the indirect pancreatic function tests detect a greater percentage of subjects with exocrine pancreatic insufficiency than the secretin-caerulein test.


OBJECTIVE
To evaluate faecal pancreatic elastase-1 assay in monitoring patients with coeliac disease.


METHODS
Thirty patients with coeliac disease (11 m; age range 1-7 years) completed a 2-month follow-up. As controls, we studied two sex-, age-matched patient groups: a) 15 patients with cystic fibrosis, b) 40 surgical patients without gastroenterological disease.


METHODS
In all coeliac subjects, stools were collected over 24 hours at diagnosis and then 30 and 60 days after commencement of the gluten-free diet; on a sample of the faeces we assayed elastase-1 activity. In the control patients, faeces were collected over 24 hours for elastase-1 assay only once. The coeliac patients only underwent the secretin-caerulein test, at diagnosis.


RESULTS
Ten out of 30 coeliac patients (33%) had subnormal faecal elastase-1 values at diagnosis, while all the surgical controls had values within the normal range; median values in coeliac patients were significantly lower than those of the surgical controls (median 287 mcg/g, 95% CI 271-430, versus 487 mcg/g, 95% CI 426-538, p < 0.007). Cystic fibrosis patient values (median 10 mcg/g, 95% CI 7-155) were significantly lower than both those of coeliac patients and those of the surgical controls (p < 0.0001). The secretin-caerulein test showed that 7/30 coeliac patients (23%) had a deficiency in one or more pancreatic enzymes; all these subjects had below normal faecal elastase-1 values. During the follow-up, we observed a progressive reduction in the number of coeliacs with pancreatic impairment; however, after 2 months of gluten-free diet, faecal elastase-1 deficiency persisted in 2/30 coeliacs.


CONCLUSIONS
Faecal elastase-1 determination in coeliac patients reveals a similar frequency and duration of pancreatic impairment to those observed in studies performed using the faecal chymotrypsin assay; a reduction in faecal elastase-1 values can be linked to "non-typical pancreatic diseases".
Carroccio
A
A
Division of Internal Medicine, University of Palermo, Italy.
Iacono
G
G
Ippolito
S
S
Verghi
F
F
Cavataio
F
F
Soresi
M
M
Giannitrapani
L
L
Notarbartolo
A
A
Montalto
G
G
D002446:Celiac Disease / Q000175:diagnosis* / Q000201:enzymology; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000201:enzymology; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D016011:Normal Distribution; D010196:Pancreatic Elastase / Q000032:analysis*; D010186:Pancreatic Function Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
D010196:Pancreatic Elastase