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Are we missing early pancreatic dysfunction? Expanding faecal elastase testing beyond pancreatic disease.

Connor E M Cotton1, Andrew D Hopper1,2, David S Sanders1,2

  • 1Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals.

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Summary

Pancreatic exocrine insufficiency (PEI) is common in patients with gastrointestinal issues. Early detection via fecal elastase-1 (FE-1) testing can identify pancreatic dysfunction for timely intervention.

Keywords:
chronic pancreatitisfaecal elastaseirritable bowel syndromepancreatic exocrine insufficiency

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Area of Science:

  • Gastroenterology
  • Pancreatology
  • Internal Medicine

Background:

  • Pancreatic exocrine insufficiency (PEI) is often linked to pancreatic diseases but is underdiagnosed in patients with general gastrointestinal symptoms.
  • Overlapping symptoms with conditions like celiac disease, IBD, and IBS can delay PEI diagnosis.

Purpose of the Study:

  • To review the prevalence of PEI in gastroenterology cohorts.
  • To evaluate the performance and utility of fecal elastase-1 (FE-1) testing.
  • To explore PEI in patients with irritable bowel syndrome (IBS)-type symptoms and discuss 2025 European guideline updates.

Main Methods:

  • Systematic review of prevalence data.
  • Meta-analysis of FE-1 performance.
  • Analysis of cohort data for PEI in IBS-type patients.

Main Results:

  • PEI prevalence ranges from 11-21% in unselected gastroenterology cohorts.
  • FE-1 testing shows high sensitivity for moderate-to-severe PEI; repeat testing can clarify borderline results.
  • PEI may indicate early pancreatic dysfunction in some IBS-type patients, offering intervention opportunities.

Conclusions:

  • PEI's relevance extends beyond primary pancreatic diseases.
  • Proactive FE-1 testing can enable earlier recognition and intervention for pancreatic dysfunction.
  • Early identification may allow for lifestyle modifications at a potentially reversible stage of pancreatic dysfunction.