The Lundh test and faecal elastase 1 determination in chronic pancreatitis: a comparative study.
OBJECTIVE
A reduced exocrine pancreatic function supports the diagnosis of chronic pancreatitis (CP) in symptomatic patients. A sensitive test for a reduced exocrine function is decisive, especially when morphological changes are missing. The aim of this study was to compare the indirect faecal elastase 1 (FE-1) test with the direct Lundh test in patients with and without definite diagnostic imaging findings.


METHODS
Eighty-nine patients with clinical signs suggesting CP or having an established diagnosis of CP had a Lundh test and an estimation of FE-1 performed. All patients underwent abdominal ultrasonography and/or computed tomography.


RESULTS
A significant correlation (r = 0.70, p < 0.02) was found between FE-1 and meal-stimulated intraduodenal lipase. Using the Lundh test as reference, the predictive values of a positive and negative FE-1 test were for all patients investigated 81 and 73%, respectively. Patients with equivocal imaging findings had lower predictive values (positive predictive value 57%; negative predictive value 71%) as compared with patients with moderate or marked imaging findings (positive predictive value 84%; negative predictive value 78%). Fair to moderate chance-corrected agreement was found between Lundh test and FE-1 concentration.


CONCLUSIONS
In patient with imaging findings suggesting CP, FE-1 determination is a highly sensitive test for exocrine pancreatic function, but in patients with equivocal imaging findings, the predictive power of FE-1 limits the test to serve as a reliable diagnostic tool.
Gredal
C
C
Section of Gastroenterology, Department of Internal Medicine, Glostrup University Hospital, Glostrup, Denmark.
Madsen
L G
LG
Larsen
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004796:Clinical Enzyme Tests; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000378:metabolism*; D010186:Pancreatic Function Tests; D010195:Pancreatitis / Q000175:diagnosis*; D011237:Predictive Value of Tests
D010196:Pancreatic Elastase