Fecal elastase test: evaluation of a new noninvasive pancreatic function test

Area of Science:

• Gastroenterology
• Pancreatic Physiology
• Diagnostic Testing

Background:

• Pancreatic elastase is stable in the gastrointestinal tract.
• A new enzyme-linked immunosorbent assay (ELISA) allows for fecal elastase-1 measurement.
• Chronic pancreatitis (CP) diagnosis often relies on indirect pancreatic function tests.

Purpose of the Study:

• To evaluate the fecal elastase test (FET) performance.
• To compare FET with other indirect pancreatic function tests (serum pancreolauryl test [PLT] and fecal chymotrypsin test [FCT]).
• To assess FET's utility in diagnosing chronic pancreatitis.

Main Methods:

• A study included 69 patients: 20 with CP, 13 with other pancreatic diseases, and 36 with gastrointestinal/hepatic disorders.
• Fecal elastase-1 concentration, fecal chymotrypsin activity (FCT), and serum pancreolauryl test (PLT) were measured.
• Patients' conditions were assessed using endoscopic retrograde pancreatography (ERP) and computed tomography (CT).

Main Results:

• Fecal elastase concentration was significantly reduced in moderate and severe CP patients, similar to PLT.
• FET demonstrated 100% sensitivity for moderate to severe CP and 83% specificity.
• Unlike PLT, FET was unaffected by gastric resection, malabsorption, or altered gastric motility. Unlike FCT, FET was unaffected by oral enzyme supplementation.

Conclusions:

• The fecal elastase test (FET) is a simple and accurate functional test for diagnosing CP.
• FET is minimally influenced by extrapancreatic disorders.
• FET is a reliable diagnostic tool, unaffected by exogenous enzyme therapy.