What is the significance of elevated pancreatic elastase?

From the Guidelines

Elevated pancreatic elastase in stool samples indicates normal or enhanced pancreatic exocrine function, suggesting that the pancreas is functioning properly or potentially overactive, and no specific treatment is needed for elevated pancreatic elastase alone, as it is not pathological. This enzyme is produced by the pancreas and remains stable during intestinal transit, making it a reliable marker for pancreatic function [ 1, 1 ]. When pancreatic elastase levels are above normal (typically >200 μg/g of stool), it is generally reassuring and indicates that the patient does not have pancreatic exocrine insufficiency. However, if the elevation is extreme and accompanied by symptoms like abdominal pain, it might warrant further investigation for conditions such as acute pancreatitis 1. The clinical significance of elevated pancreatic elastase should always be interpreted in the context of the patient's symptoms and other diagnostic findings. Most clinicians are more concerned with low pancreatic elastase values (<200 μg/g), which suggest pancreatic insufficiency requiring enzyme replacement therapy 1.

Key Points to Consider

• Elevated pancreatic elastase is not a pathological finding and does not require specific treatment 1.
• The test is useful for diagnosing moderate to severe pancreatic insufficiency but not for mild cases 1.
• Faecal elastase-1 has been well characterised as a sensitive biomarker for moderate to severe pancreatic insufficiency with sensitivities of 73–100% and specificities of 80–100% 1.
• The test should be used with care in patients with liquid stool, as this can lead to false positive results 1.

Clinical Implications

• Elevated pancreatic elastase levels should be interpreted in the context of the patient's symptoms and other diagnostic findings 1.
• Low pancreatic elastase values (<200 μg/g) suggest pancreatic insufficiency requiring enzyme replacement therapy 1.
• Patients with symptoms such as abdominal pain, steatorrhea, or weight loss should be further investigated for underlying conditions, regardless of pancreatic elastase levels 1.

From the Research

Significance of Elevated Pancreatic Elastase

Elevated pancreatic elastase levels can be indicative of various pancreatic diseases. The significance of these elevated levels can be understood by examining the findings of several studies:

• Elevated pancreatic elastase levels have been found in patients with acute pancreatitis, with levels remaining elevated longer than other enzymes such as amylase and pancreatic isoamylase 2.
• In chronic pancreatitis, elevated elastase levels were found in the majority of patients studied during a painful relapse, while most patients studied during clinical remission had normal or below-normal elastase levels 2.
• A study comparing elastase-1 with trypsin, lipase, and amylase serum levels in pancreatic diseases found that about 50% of patients with chronic pancreatic disease showed increased levels of serum elastase, sometimes even in the face of long-lasting pain-free periods and/or severe pancreatic impairment 3.
• The fecal elastase test (FET) has been evaluated as a noninvasive pancreatic function test, with results showing that FET is a simple and accurate functional test for chronic pancreatitis, hardly influenced by extrapancreatic disorders or therapy with exogenous enzymes 4.
• Serum pancreatic enzyme behavior during the course of acute pancreatitis has been studied, with results indicating that elastase 1 is the most sensitive marker of acute pancreatic damage in later stages of the disease 5.
• Serum elastase I levels have been found to be significantly higher in patients with acute, acute relapsing, and chronic relapsing pancreatitis, and abnormal levels have been found in patients with pancreatic cancer, especially those with cancer of the pancreatic head 6.

Diagnostic Value

The diagnostic value of elevated pancreatic elastase levels can be summarized as follows:

• Elevated elastase levels can indicate pancreatic disease, including acute and chronic pancreatitis, and pancreatic cancer.
• Elastase levels can remain elevated longer than other enzymes, making them a useful marker for diagnosing pancreatic disease.
• The fecal elastase test (FET) is a noninvasive and accurate test for chronic pancreatitis.
• Serial measurements of elastase levels can help monitor the progression of pancreatic disease and response to treatment.

Clinical Implications

The clinical implications of elevated pancreatic elastase levels are:

• Elevated elastase levels can aid in the diagnosis of pancreatic disease, allowing for early intervention and treatment.
• Monitoring elastase levels can help clinicians assess the severity of pancreatic disease and adjust treatment accordingly.
• The use of FET as a noninvasive test can reduce the need for invasive procedures and improve patient outcomes.