What is the role of pancreatic elastase (PE) on stool, in diagnostic testing, and its relevance to clinical application?

From the Guidelines

Pancreatic elastase plays a crucial role in protein digestion and serves as an important clinical marker for exocrine pancreatic function, with stool elastase testing being the most appropriate initial test for suspected pancreatic insufficiency, as indicated by a fecal elastase level <100 mg/g of stool providing good evidence of EPI 1.

Role of Pancreatic Elastase in Stool

The role of pancreatic elastase in stool is to serve as a marker for exocrine pancreatic function. Stool elastase testing is a non-invasive diagnostic tool that involves collecting a small stool sample, which is then analyzed using an enzyme-linked immunosorbent assay (ELISA).

• Normal elastase levels are typically above 200 μg/g of stool
• Values below 100 μg/g strongly suggest pancreatic insufficiency
• Values between 100-200 μg/g indicate mild to moderate insufficiency

Testing for Pancreatic Insufficiency

Testing for pancreatic insufficiency involves the use of fecal elastase testing, which is the most appropriate initial test, as stated in Best Practice Advice 4 1.

• A fecal elastase level <100 mg/g of stool provides good evidence of EPI
• Levels of 100–200 mg/g of stool are indeterminate for EPI
• Fecal elastase testing can be performed while on pancreatic enzyme replacement therapy 1

Relevance to Clinical Application

The relevance of pancreatic elastase to clinical application is significant, as it can indicate conditions such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, or diabetes-related pancreatic dysfunction 1.

• When pancreatic insufficiency is confirmed, treatment typically involves pancreatic enzyme replacement therapy (PERT) with products containing lipase, amylase, and protease
• The advantage of stool elastase testing over other methods is that it doesn't require special diet preparation, medication discontinuation, or timed collections, making it convenient for both patients and clinicians
• Insulin is a trophic factor for pancreatic acinar cells and diabetes may impact the risk of developing EPI, with long-standing diabetes mellitus type 1 diminishing pancreatic digestive enzyme secretion and fecal human elastase-1 (FE-1) levels 1

From the Research

Role of Pancreatic Elastic on Stool

• The role of pancreatic elastic on stool is closely related to the diagnosis and treatment of pancreatic exocrine insufficiency (PEI) 2, 3, 4, 5, 6.
• Pancreatic elastic, also known as elastase, plays a crucial role in the digestion of proteins and is often used as a marker for pancreatic function 2.
• Studies have shown that elastase levels can be used to diagnose PEI and monitor the effectiveness of treatment 4, 6.

Testing for Pancreatic Elastic

• Several tests are available to measure pancreatic elastic, including the short endoscopic secretin test (EST) and the fecal elastase 1 (FE1) test 4.
• The EST involves collecting duodenal juice after stimulation with secretin and measuring the levels of bicarbonate and elastase 4.
• The FE1 test involves measuring the levels of elastase in stool samples 4.
• Studies have shown that the EST is superior to the FE1 test in diagnosing PEI 4.

Relevance to Clinical Application

• Pancreatic enzyme replacement therapy (PERT) is a common treatment for PEI, and pancreatic elastic plays a crucial role in this therapy 3, 5, 6.
• PERT involves taking supplements of pancreatic enzymes, including elastase, to replace the deficient enzymes in the pancreas 3.
• Studies have shown that PERT can improve the symptoms of PEI, including stool frequency and consistency, and can also improve the absorption of nutrients 5, 6.
• The effectiveness of PERT can be monitored by measuring the levels of pancreatic elastic and other enzymes in stool samples 6.