Low Fecal Elastase-1: A Non-negligible Factor in Functional Dyspepsia Patients

Functional dyspepsia (FD) is one of the most prevalent functional gastrointestinal disorders. The occurrence of dyspepsia has been reported to be associated with a deficiency or dysfunction of digestive enzymes. Although the pancreas plays a critical role in secreting digestive enzymes, the relationship between FD and pancreatic exocrine insufficiency (PEI) remains unclear. This study aims to evaluate the prevalence of low Fecal elastase-1 (FE-1) level, a recognized indicator of PEI, in FD patients and explore potential risk factors contributing to this condition.

This cross-sectional study enrolled 76 FD patients. The FE-1 level was measured using a commercial ELISA kit. An FE-1 level below 200 μg/g stool was defined as abnormal. Clinical characteristics and gut microbiota composition were compared between FD patients with low FE-1 level (FE-L) and those with normal FE-1 level (FE-N). Logistic regression analysis was used to identify independent risk factors for low FE-1 level in FD patients.

The prevalence of low FE-1 level among FD patients was 19.7%. Compared to the FE-N group, the FE-L group exhibited higher gastrointestinal symptoms scores, anxiety scores and lower quality of life scores (P < 0.05). Logistic regression analysis revealed that male gender and anxiety state were independent risk factors for low FE-1 level. Gut microbiota analysis demonstrated that Prevotella were significantly enriched, while Bacteroides and Bifidobacterium were decreased in the FE-L group (LDA > 3, P < 0.05).

The present study suggests that a subset of patients with FD have FE-1 secretion insufficiency and might benefit from pancreatic enzyme supplementation therapy.