Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis.
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).


METHODS
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 (< or =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.
Walkowiak
Jaroslaw
J
Institute of Pediatrics, Karol Marcinkowski University of Medical Sciences, Poznan, Poland. jarwalk@am.poznan.pl
Herzig
Karl-Heinz
KH
Strzykala
Krystyna
K
Przyslawski
Juliusz
J
Krawczynski
Marian
M
D000293:Adolescent; D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis / Q000201:enzymology; D002648:Child; D002675:Child, Preschool; D002918:Chymotrypsin / Q000032:analysis*; D004796:Clinical Enzyme Tests / Q000706:statistics & numerical data; D003124:Colorimetry / Q000706:statistics & numerical data; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000201:enzymology*; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay / Q000706:statistics & numerical data; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000201:enzymology*; D005243:Feces / Q000737:chemistry / Q000201:enzymology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010179:Pancreas / Q000201:enzymology; D010196:Pancreatic Elastase / Q000032:analysis*; D010186:Pancreatic Function Tests / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity
D002918:Chymotrypsin; D010196:Pancreatic Elastase