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Serum Laboratory Studies, Stool Test, Breath Test

Serum Laboratory Studies, Stool Test, Breath Test

Gastrointestinal (GI) diagnostic studies are pivotal in confirming, ruling out, diagnosing, or staging various diseases, including cancers. Following diagnosis, allocating time for discussions with the patient and providing informational resources is crucial. Diagnostic assessments of the GI tract often occur in outpatient settings like endoscopy suites or GI labs. Preparation for these tests may include dietary restrictions, fasting, liquid bowel preparations, laxatives, enemas, and the...

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Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids

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Fecal elastase measurement- beware; A cautionary tale.

C Mel Wilcox¹, Huy Tran¹

¹Digestive Health Institute, Orlando Health, Orlando Fl.

The American Journal of the Medical Sciences

|October 23, 2025

Summary

This summary is machine-generated.

Fecal elastase testing (FE-1) is often misinterpreted for diagnosing exocrine pancreatic insufficiency (EPI). Most patients referred with abnormal FE-1 results do not have EPI, highlighting the need for better education on appropriate test use.

Keywords:

Chronic pancreatitis Exocrine pancreatic insufficiency Fecal elastase

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Area of Science:

Gastroenterology
Pancreatic Diseases
Diagnostic Testing

Background:

Fecal elastase (FE-1) testing is increasingly used for diagnosing exocrine pancreatic insufficiency (EPI).
However, its application in diagnosing diarrhea can lead to inaccurate interpretations.
This may result in unnecessary further testing and pancreatic enzyme prescriptions.

Purpose of the Study:

To evaluate the diagnostic accuracy of fecal elastase (FE-1) testing in patients referred for suspected exocrine pancreatic insufficiency (EPI).
To assess the clinical outcomes and final diagnoses in patients undergoing FE-1 testing.
To identify potential overutilization and misinterpretation of FE-1 tests.

Main Methods:

Prospective evaluation of 54 patients referred to a pancreas clinic for suspected EPI over 24 months.
Utilized fecal elastase (FE-1) measurement, comprehensive patient history, and stool analysis.
Correlated FE-1 results with subsequent imaging (abdominal imaging, endoscopic ultrasound) and final diagnoses.

Main Results:

The median FE-1 concentration was 130 µg/g; diarrheal stool submission was common.
Only 6 patients had established risk factors for pancreatic disease.
Irritable bowel syndrome was the most frequent diagnosis (61%), with only 3 patients diagnosed with chronic pancreatitis and true EPI.

Conclusions:

Most patients with abnormal FE-1 results do not have malabsorption or EPI.
FE-1 testing is frequently misinterpreted and potentially overutilized.
Enhanced education is crucial for appropriate use and interpretation of FE-1 testing in clinical practice.