Comparing the urinary pancreolauryl ratio and faecal elastase-1 as indicators of pancreatic insufficiency in clinical practice.
BACKGROUND
The urine pancreolauryl ratio (uPLR) and, more recently, the faecal pancreatic elastase-1, are widely used for the noninvasive diagnosis of exocrine pancreatic insufficiency. Both tests have previously been validated against 'gold standard' tests of pancreatic function, but their use in a clinical setting has never been directly compared.


METHODS
We performed a comparative study of the pancreolauryl ratio (PLR) and the faecal elastase-1 (FE-1) test in patients with a clinical suspicion for pancreatic insufficiency. The results were compared with the clinical response to pancreatic enzyme supplementation using pre-defined criteria.


RESULTS
Forty-five patients were enrolled in the study and 33 were given a trial of pancreatic enzyme supplementation. Twenty-four out of these 33 showed a positive clinical response to enzyme supplements. Of the 24 responders, 19 had positive FE-1 (<200 microg/g faeces), but only 12 had a positive uPLR (<20). There was a significant correlation between the FE-1 result and clinical response to enzyme supplements (p = 0.01), but not between the PLR and clinical response (p = 0.15).


CONCLUSIONS
FE-1 is a simpler test for the patient to perform and more accurately predicts the response to pancreatic enzyme supplementation in patients with chronic, unexplained diarrhoea with a clinical suspicion of pancreatic insufficiency than the PLR. This makes the FE-1 of greater use in clinical practice than the PLR.
Elphick
D A
DA
Department of Gastroenterology, Barnsley District General Hospital, Barnsley, UK. elphickdh@hotmail.com
Kapur
K
K
D015415:Biomarkers / Q000652:urine; D003967:Diarrhea / Q000175:diagnosis / Q000378:metabolism; D004798:Enzymes / Q000008:administration & dosage; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism*; D005243:Feces; D005452:Fluoresceins / Q000493:pharmacokinetics; D006801:Humans; D010196:Pancreatic Elastase / Q000378:metabolism*; D010186:Pancreatic Function Tests; D045602:Steatorrhea / Q000175:diagnosis / Q000378:metabolism
D015415:Biomarkers; D004798:Enzymes; D005452:Fluoresceins; C034833:fluorescein dilaurate; D010196:Pancreatic Elastase