How useful is fecal pancreatic elastase 1 as a marker of exocrine pancreatic disease?
OBJECTIVE
To evaluate the role of fecal elastase 1 (E1) as a marker of exocrine pancreatic insufficiency (PI).


METHODS
Fecal E1 was measured in patient groups with (1) failure to thrive but no pancreatic or intestinal disease (disease control patients); (2) PI; (3) pancreatic sufficiency; and (4) steatorrhea caused by a variety of intestinal diseases.


RESULTS
Fecal E1 in all disease control patients exceeded 200 microg/g stool. Only 1 (2%) of 50 patients with PI exceeded the minimum reference value of 100 microg/g stool. In contrast, 3 (11%) of 28 patients with pancreatic sufficiency (with Shwachman-Diamond syndrome) had fecal E1 concentrations <100 microg/g stool, as did 5 (20%) of 25 patients with steatorrhea from intestinal causes, all of whom had diluted feces caused by short gut.


CONCLUSIONS
Fecal E1 is a useful noninvasive screening test of PI in childhood. A negative test (>100 microg/g stool) had 99% predictive value for ruling out PI. However, a positive test in those with short gut or Shwachman-Diamond syndrome must be interpreted with caution.
Beharry
Satti
S
Department of Pediatrics, the University of Toronto, Ontario, Canada.
Ellis
Lynda
L
Corey
Mary
M
Marcon
Margaret
M
Durie
Peter
P
D000293:Adolescent; D015415:Biomarkers; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000209:etiology; D005243:Feces / Q000737:chemistry; D006801:Humans; D007223:Infant; D008286:Malabsorption Syndromes / Q000150:complications; D010196:Pancreatic Elastase / Q000378:metabolism*; D010186:Pancreatic Function Tests / Q000379:methods*; D012680:Sensitivity and Specificity
D015415:Biomarkers; D010196:Pancreatic Elastase