Faecal elastase 1: not helpful in diagnosing chronic pancreatitis associated with mild to moderate exocrine pancreatic insufficiency

Lankisch, P. G.; Schmidt, Iris; König, H.; Lehnick, Dirk; Knollmann, R; Löhr, Matthias; Liebe, Stefan

doi:10.1136/gut.42.4.551

Cited by 170 publications

(102 citation statements)

References 12 publications

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“…In selected cases, in the presence of clinical suspicion and minimal morphological changes, direct function tests can help in the diagnosis [112]. Tubeless functions tests (fecal elastase, fecal chymotrypsin) can be used in the follow-up of selected patients for identifying a progressive impairment in pancreatic function by which the chronicity of the inflammatory process can be confirmed [107,109]. Fecal elastase-1 test does not require a timed stool collection or special diet, has a high negative predictive value for pancreatic insufficiency, and a good sensitivity in patients with moderate and severe pancreatic failure [18,113].…”

Section: C7mentioning

confidence: 99%

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Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

165

112

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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Section: C7mentioning

confidence: 99%

“…they are not diagnostic [105,106]. Conversely, tubeless tests of pancreatic function can detect severe exocrine insufficiency only [107][108][109]. An endoscopic pancreatic test has recently been proposed as an alternative tool [110,111].…”

Section: C7mentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

165

112

View full text Add to dashboard Cite

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“…9 -11 In adult chronic pancreatitis patients, the determination of E1 and ChT were usually performed in small groups of patients and healthy subjects (HS). 9,[12][13][14][15] Moreover, the statistical analysis was conducted only in 1 of them. 15 Therefore, the aim of the study was to compare the sensitivity and the specificity of the fecal E1 test with the fecal ChT test in a large cohort of CF patients and HS.…”

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confidence: 99%

Fecal Elastase-1 Is Superior to Fecal Chymotrypsin in the Assessment of Pancreatic Involvement in Cystic Fibrosis

Walkowiak¹,

Herzig

Strzykała³

et al. 2002

Pediatrics

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ABSTRACT.Objective. Exocrine pancreatic function in patients with cystic fibrosis (CF) can be evaluated by direct and indirect tests. In pediatric patients, indirect tests are preferred because of their less invasive character, especially in CF patients with respiratory disease. Fecal tests are noninvasive and have been shown to have a high sensitivity and specificity. However, there is no comparative study in CF patients. Therefore, the aim of the present study was to compare the sensitivity and the specificity of the fecal elastase-1 (E1) test with the fecal chymotrypsin (ChT) test in a large cohort of CF patients and healthy subjects (HS).Design. One hundred twenty-three CF patients and 105 HS were evaluated. In all subjects, E1 concentration and ChT activity were measured. In the CF group, fecal fat excretion was also determined. The sensitivity and specificity of the fecal E1 test and ChT test were compared.Results. With a cutoff level of 3 U/g, ChT specificity in HS was similar to that of E1, but E1 sensitivity in CF patients was significantly higher (90.2% vs 81.3%). With a cutoff level of 6 U/g, ChT and E1 sensitivity in CF patients was identical, but E1 specificity in HS was again significantly higher (98.1% vs 90.5%). In all CF patients with severe steatorrhea (>15 g/d), E1 concentrations were abnormal and ChT activity was lower than 3 U/g. In contrast, in pancreatic-sufficient patients and patients with mild steatorrhea (<15 g/d), the E1 sensitivity was significantly higher compared with ChT (69.2% vs 41.0%).Conclusions. The fecal E1 test is superior to fecal ChT determination in the assessment of CF pancreatic involvement in pancreatic-sufficient patients and those patients with mild steatorrhea. Pediatrics 2002;110(1). URL: http://www.pediatrics.org/cgi/content/full/110/1/e7; fecal elastase-1, fecal chymotrypsin, exocrine pancreatic function, cystic fibrosis.

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“…This value was similar to previous find- ings in type 1 and 2 diabetic patients (1-5) as well as to results from our present type 1 control group and three times higher than that in the healthy control subjects. Fecal elastase has been shown to have good sensitivity and specificity for moderate and severe exocrine deficiency, whereas it is criticized as having less sensitivity in mild exocrine deficiency (24). The response rate of 60.5% was satisfactory, and there were no differences in age or diabetes duration between the study population and the subjects with MODY3 in the Norwegian MODY Registry.…”

Section: Cel Variantsmentioning

confidence: 73%

Pancreatic Exocrine Dysfunction in Maturity-Onset Diabetes of the Young Type 3

et al. 2008

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OBJECTIVE -Exocrine pancreas dysfunction is seen in 10 -30% of patients with type 1 and 2 diabetes. We have recently identified a syndrome of diabetes and exocrine pancreas dysfunction attributable to mutations in the carboxyl ester lipase (CEL) gene. We wanted to investigate the prevalence of pancreatic exocrine dysfunction in patients with maturity-onset diabetes of the young type 3 (MODY3).RESEARCH DESIGN AND METHODS -All 119 patients with MODY3 in the Norwegian MODY Registry were invited to participate, and 70 (60.5%) responded, among whom 63 were adults. Control groups included 140 subjects with type 1 diabetes and 78 nondiabetic control subjects. Pancreatic dysfunction was defined by fecal elastase deficiency. Fecal fat excretion was measured in 25 patients with fecal elastase deficiency. CEL was investigated for sequence changes.RESULTS -We found a prevalence of fecal elastase deficiency of 12.7% in adult patients with MODY3, compared with 18.6% in patients with type 1 diabetes and 3.8% in nondiabetic control subjects. The six patients with MODY3 with fecal elastase deficiency available for analysis all had increased fecal fat excretion. Fecal elastase decreased with age. Controlled for age, patients with MODY3 still had decreased fecal elastase compared with control subjects. Twelve of 70 patients (17%) had single-base insertions in CEL exon 11. Two of these had fecal elastase deficiency.CONCLUSIONS -The prevalence of pancreatic exocrine dysfunction was 12.7% in a cohort of 63 adult patients with MODY3, similar to the prevalence among type 1 diabetic patients. Fecal fat excretion was increased in all patients with MODY3 with fecal elastase deficiency who were investigated, underscoring the potential clinical importance of the exocrine dysfunction. Diabetes Care 31:306-310, 2008A lthough reported to be present in 10 -30% of patients with type 1 and type 2 diabetes (1-5) compared with ϳ4% of nondiabetic subjects, severe dysfunction of the exocrine pancreas is often not recognized in clinical practice. Exocrine dysfunction is most frequently diagnosed by fecal elastase deficiency. Studies show that steatorrhea is common in patients with diabetes and fecal elastase deficiency (6), suggesting clinical implications such as increased risk of osteoporosis and other diseases associated with deficiencies in fat-soluble vitamins. Fecal elastase levels have also been reported to correlate with residual ␤-cell secretion and glycemic control in type 1 diabetic patients (7).Several mechanisms have been proposed to explain the impaired pancreatic exocrine function in patients with diabetes. Diabetes has usually been regarded as the primary process. Alternative hypotheses that have been presented are 1) insulin deficiency, resulting in a deficit of the trophic action of insulin on acinar cells (8); 2) diabetic microangiopathy, with arterial lesions causing pancreatic fibrosis; 3) diabetic autonomic neuropathy, leading to impaired enteropancreatic reflexes; and 4) hormone suppression caused by high levels of circulating g...

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Faecal elastase 1: not helpful in diagnosing chronic pancreatitis associated with mild to moderate exocrine pancreatic insufficiency

Cited by 170 publications

References 12 publications

Italian consensus guidelines for chronic pancreatitis

Italian consensus guidelines for chronic pancreatitis

Fecal Elastase-1 Is Superior to Fecal Chymotrypsin in the Assessment of Pancreatic Involvement in Cystic Fibrosis

Pancreatic Exocrine Dysfunction in Maturity-Onset Diabetes of the Young Type 3

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