What is the significance of elevated pancreatic elastase at 156?

From the Guidelines

A pancreatic elastase level of 156 μg/g is considered indeterminate for exocrine pancreatic insufficiency (EPI), and further evaluation is necessary to determine the presence and severity of EPI. According to the AGA clinical practice update on the epidemiology, evaluation, and management of EPI 1, a fecal elastase level between 100-200 μg/g is indeterminate for EPI.

Key Considerations

• The patient's clinical presentation, including symptoms such as steatorrhea, weight loss, and bloating, should be taken into account when interpreting the fecal elastase result 1.
• The patient's medical history, including the presence of high-risk or moderate-risk clinical conditions for EPI, such as chronic pancreatitis or cystic fibrosis, should also be considered 1.
• Further testing, such as fecal fat testing or direct pancreatic function tests, may be necessary to confirm the diagnosis of EPI 1.

Management

• If EPI is suspected or confirmed, treatment with pancreatic enzyme replacement therapy (PERT) may be necessary to improve symptoms and prevent complications related to fat malabsorption and malnutrition 1.
• The initial dose of PERT should be at least 40,000 USP units of lipase during each meal in adults, with adjustments made based on symptom response and meal size and fat content 1.
• Fat-soluble vitamin supplementation (A, D, E, K) may also be necessary to prevent deficiencies 1.

Monitoring

• Regular monitoring of the patient's symptoms, nutritional status, and fat-soluble vitamin levels is necessary to assess the effectiveness of treatment and make adjustments as needed 1.
• A baseline dual-energy x-ray absorptiometry scan should be obtained and repeated every 1-2 years to monitor for changes in bone density 1.

From the Research

Significance of Elevated Pancreatic Elastase

• The significance of elevated pancreatic elastase at 156 is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, the studies discuss the importance of pancreatic elastase levels in diagnosing pancreatic exocrine insufficiency (PEI) and monitoring the effectiveness of pancreatic enzyme replacement therapy (PERT) 3, 4, 5, 6.
• A fecal elastase-1 (FE1) level of 100-200 mcg/g is considered mild pancreatic exocrine dysfunction, while a level below 100 mcg/g indicates moderate to severe dysfunction 3.
• Elevated pancreatic elastase levels may indicate normal or near-normal pancreatic exocrine function, but the exact threshold for what constitutes an "elevated" level is not specified in the provided studies.
• It is essential to consider the clinical context and other diagnostic markers, such as coefficient of fat absorption (CFA) and serum fat-soluble vitamin levels, to determine the significance of elevated pancreatic elastase levels 3.

Diagnostic Evaluation and Replacement Therapy

• Fecal elastase-1 (FE1) level is a widely used non-invasive test for pancreatic enzyme output and can help diagnose PEI 3, 4, 5, 6.
• Pancreatic enzyme replacement therapy (PERT) is the cornerstone of treatment for patients with PEI, and the dosage should be individualized based on the patient's needs 2, 4, 5.
• The studies emphasize the importance of proper diagnosis, treatment, and monitoring of PEI to prevent malabsorption, weight loss, and nutrient deficiencies 2, 3, 4, 5, 6.