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Diagnostic Performance of Fecal Elastase and Risk Factors for Exocrine Pancreatic Insufficiency in Children with
Vybhav Venkatesh Gummadi1, Tanja Gonska2, Veronique D Morinville3
1Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Insights
Fecal elastase (FE) helps rule out exocrine pancreatic insufficiency (EPI) in children with pancreatitis, though it has limitations. Genetic factors increase EPI risk, requiring closer monitoring in these pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Pancreatic Diseases
- Diagnostic Accuracy
Background:
- Exocrine pancreatic insufficiency (EPI) is a concern in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP).
- Accurate diagnosis of EPI is crucial for appropriate management and preventing complications.
Purpose of the Study:
- To assess the diagnostic performance of fecal elastase (FE) for EPI in children with ARP/CP.
- To identify risk factors associated with EPI development in this pediatric population.
Main Methods:
- Prospective analysis of demographic, clinical, and EPI data from 1007 children in the INSPPIRE-2 consortium.
- FE performance evaluated against fat malabsorption markers; Cox regression used to find EPI predictors.
Main Results:
- EPI diagnosed in 19.4% of children; FE was the primary diagnostic tool.
- FE showed low sensitivity but high negative predictive value for fat malabsorption.
- Genetic risk factors correlated with earlier EPI progression (HR 1.56).
Conclusions:
- EPI affects nearly 20% of children with ARP/CP.
- FE is useful for excluding EPI in children.
- Children with genetic predispositions require enhanced surveillance for EPI.
Objective:
To evaluate the diagnostic performance of fecal elastase (FE) in exocrine pancreatic insufficiency (EPI) and examine the risk factors for EPI in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP).
Study Design:
We analyzed prospectively collected demographic, clinical, and EPI data of children with ARP or CP (n = 1007) enrolled in the INSPPIRE-2 (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) consortium. FE performance was assessed against individual markers of fat malabsorption and a composite reference standard in which the presence of any 1 of the following was considered consistent with fat malabsorption in lieu of a gold-standard pancreas function test: (1) clinical diagnosis of EPI, (2) vitamin A or E deficiency, or (3) body mass index z-score ≤-2. Cox regression models were used to identify predictors of EPI.
Results:
EPI was diagnosed in 195/1007 (19.4%) children with ARP/CP, with FE being the most commonly used diagnostic tool. FE demonstrated low sensitivity (55.8% and 65.1%), moderate specificity (82.8% and 75.5%), and a high negative predictive value (92% and 93%), at cut-offs of 100 μg/g and 200 μg/g stool, respectively, in detecting at least 1 marker of fat malabsorption. The 7-year cumulative incidence of EPI after the first pancreatitis episode was 24%. Genetic risk factors were associated with earlier progression to EPI (hazard ratio 1.56; 95% confidence interval 1.02-2.39).
Conclusions:
EPI affects nearly 20% of children with ARP/CP. FE is a valuable diagnostic tool in ruling out EPI. Children with genetic risk factors need closer surveillance due to an increased risk for developing EPI.
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