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

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.