From the Guidelines
Low pancreatic elastase in stool is primarily caused by pancreatic exocrine insufficiency (PEI), which can result from various conditions, including chronic pancreatitis, cystic fibrosis, pancreatic cancer, and previous pancreatic surgery, as highlighted in the most recent study 1. The most common causes of low pancreatic elastase in stool include:
- Chronic pancreatitis, often resulting from long-term alcohol abuse or gallstones, leading to progressive inflammation and scarring of the pancreatic tissue
- Cystic fibrosis, which causes thick mucus to block pancreatic ducts, preventing enzyme release
- Pancreatic cancer, which can physically obstruct ducts or destroy functional tissue
- Previous pancreatic surgery, which can damage the pancreas and lead to PEI Other potential causes of low pancreatic elastase in stool include:
- Diabetes mellitus, particularly type 1
- Celiac disease
- Inflammatory bowel disease
- Certain medications that affect pancreatic function
- Severe malnutrition, which can impact pancreatic enzyme production According to the study 1, a fecal elastase level <100 mg/g of stool provides good evidence of PEI, and levels of 100–200 mg/g are indeterminate for PEI. Treatment typically involves pancreatic enzyme replacement therapy (PERT) with products containing lipase, amylase, and protease to aid digestion, along with addressing the underlying cause when possible, as recommended in the study 1. Additionally, the study 1 highlights the importance of nutrition in chronic pancreatitis, and the need for early identification and treatment of steatorrhea with PERT to prevent malnutrition and other complications. The study 1 also discusses the potential role of small intestinal bacterial overgrowth (SIBO) and dysbiosis in chronic pancreatitis, and the need for further research in this area. Overall, the management of low pancreatic elastase in stool requires a comprehensive approach that addresses the underlying cause, as well as the nutritional and digestive needs of the patient, as emphasized in the study 1.
From the Research
Causes of Low Pancreatic Elastase in the Stool
The causes of low pancreatic elastase in the stool can be attributed to various conditions that affect the pancreas and its ability to produce digestive enzymes. Some of the key causes include:
- Pancreatic insufficiency, which can be caused by conditions such as cystic fibrosis, pancreatic cancer, acute and chronic pancreatitis, and pancreatic surgery 2
- Exocrine pancreatic insufficiency (EPI), which can occur in diseases such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, and as a result of pancreatic surgery 3
- Intestinal inflammation, which may be linked to pancreatic insufficiency, as evidenced by the association between low fecal elastase-1 concentrations and high fecal calprotectin concentrations 4
- Malabsorption, which can occur due to inadequate pancreatic enzyme secretion, leading to steatorrhoea and creathorrhea, resulting in abdominal discomfort, weight loss, and nutritional deficiencies 3
Conditions Associated with Low Pancreatic Elastase
Several conditions have been associated with low pancreatic elastase in the stool, including:
- Cystic fibrosis, where fecal elastase-1 can be used as a measure of pancreatic exocrine function 5
- Chronic pancreatitis, where low fecal elastase-1 concentrations have been observed, indicating pancreatic insufficiency 4, 6
- Pancreatic cancer, which can cause pancreatic insufficiency and low fecal elastase-1 concentrations 2, 4
- Acute and chronic pancreatitis, where fecal elastase-1 can be used to diagnose or exclude pancreatic exocrine insufficiency 6
Diagnosis and Treatment
Diagnosis of low pancreatic elastase in the stool can be made using fecal elastase-1 tests, which are simple, rapid, and cost-effective 5, 6. Treatment of underlying conditions, such as pancreatic insufficiency, may involve pancreatic enzyme replacement therapy (PERT) to improve nutrient absorption and prevent malnutrition-related morbidity and mortality 2, 3