title: Pancreatic exocrine insufficiency: Comparing fecal elastase 1 with 72-h stool for fecal fat estimation.
abstract: BACKGROUND
  Identification of pancreatic exocrine insufficiency (PEI) is important in the management of chronic pancreatitis. The 72-h stool for fecal fat estimation (FFE) has long been considered a gold standard indirect test for the diagnosis of PEI. However, the test is cumbersome for both patients and laboratory personnel alike. In this study, we aimed to assess fecal elastase 1 (FE1) as an alternate to FFE for the diagnosis of PEI.
  
  
  METHODS
  In all, 87 consecutive patients diagnosed with chronic pancreatitis were included in this study. FFE and FE1 estimation was done for all the patients. For FE1, two cutoffs (<100 and <200 μg) were selected to define pancreatic exocrine insufficiency. The sensitivity, specificity, and positive and negative predictive values for the two cutoffs were estimated. Kappa statistics was used to assess degree of agreement between both tests.
  
  
  RESULTS
  All patients completed the study and were included in the analysis. The sensitivity, specificity, and positive and negative predictive value and PABAK (prevalence and bias adjusted kappa) for FE1 <100 μg was 84.9, 47.6, 83.6, 50, and 0.52, respectively. For FE1 <200 μg, it was 90.9, 9.5, 75.95, 25, and 0.43, respectively.
  
  
  CONCLUSIONS
  FE1 is a sensitive test; however, it does not have a good agreement with FFE. FE1 may be used as screening test for PEI in patients with chronic pancreatitis.
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India. sudipto.d.c@gmail.com.
authors.forename: Sudipta Dhar
authors.initials: SD
authors.lastname: Chowdhury
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Reuben Thomas
authors.initials: RT
authors.lastname: Kurien
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Anup
authors.initials: A
authors.lastname: Ramachandran
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Anjilivelil Joseph
authors.initials: AJ
authors.lastname: Joseph
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Ebby George
authors.initials: EG
authors.lastname: Simon
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Dutta
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Deepu
authors.initials: D
authors.lastname: David
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Bharath
authors.initials: B
authors.lastname: Kumar C
authors.affiliation: Department of Biostatistics, Christian Medical College, Vellore, 632 004, India.
authors.forename: Prassana
authors.initials: P
authors.lastname: Samuel
authors.affiliation: Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: K A
authors.initials: KA
authors.lastname: Balasubramaniam
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D002908:Chronic Disease; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000209:etiology; D005223:Fats / Q000032:analysis; D005243:Feces / Q000201:enzymology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000032:analysis*; D010195:Pancreatitis / Q000150:complications; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D015415:Biomarkers; D005223:Fats; D010196:Pancreatic Elastase
keywords: Chronic pancreatitis; Elastase; Exocrine insufficiency; Stool fat