Fecal Elastase: A Useful Test for Pancreatic Insufficiency?

Tod, Jo; Fine, David

doi:10.1007/s10620-010-1409-9

Cited by 22 publications

(13 citation statements)

References 18 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Early diagnosis of exocrine pancreatic insufficiency is challenging as symptoms may be mistakenly attributed to functional gastrointestinal disorders and image findings may be absent (10) ; however, in these patients even the gold standard (secretin-cholecystokinin or secretin-cerulein test by duodenal intubation) has low sensitivity (8) . In this setting, the noninvasive detection of fecal elastase 1, although it provides higher sensitivity and specificity than chymotrypsin (8) , has some limitations (10) , such as difficulties in diagnosing mild-moderate chronic pancreatitis and in differentiating pancreatic from non-pancreatic malabsorption (22) . Thus, fecal elastase 1 may be more useful for follow-up examinations of patients than for chronic pancreatitis diagnosis, as chronic pancreatitis is a progressive condition and fecal elastase 1 levels decreases accordingly (24) .…”

Section: Discussionmentioning

confidence: 99%

“…Fecal elastase 1 fails to distinguish primary exocrine pancreatic insufficiency from other causes of diarrhea; thus, the integrity of the intestinal mucosa should be evaluated when primary causes of pancreatic insufficiency were excluded. In spite of that, low level of fecal elastase 1 may indicate pancreatic insufficiency (22) . Although fecal elastase 1 was thoroughly studied by other authors and subject of review (10) ; the purpose of this prospective study was to evaluate the usefulness of fecal elastase 1 for the indication of pancreatic insufficiency to introduce this test in our routine clinical practice (a Hospital of the Public Service).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

Mattar

Lima

Costa

et al. 2014

Arq. Gastroenterol.

View full text Add to dashboard Cite

-Context -Fecal elastase is a noninvasive test for pancreatic insufficiency diagnosis. Objective -Evaluate the usefulness of fecal elastase 1 for the indication of exocrine pancreatic insufficiency among former alcohol addicts and patients with chronic pancreatitis. Methods -Forty-three patients with chronic pancreatitis and thirty-three asymptomatic former alcohol addicts entered the study. The levels of fecal elastase 1 were measured using a commercial kit. Pancreatic imaging findings were used to categorize the groups. Results -The levels of fecal elastase 1 were significantly lower in the patients than in the former alcohol addicts and in the group with tissue calcifications, duct alterations, or atrophy. With a cutoff level of 100 µg/g, the sensitivity of fecal elastase 1 in chronic pancreatitis was 46.51% and its specificity was 87.88% with a positive predictive value of 83.33% and a negative predictive value of 55.77%. When patients were stratified according to the severity of their pancreatitis, the sensitivity was 6.25% for mild pancreatitis and 70.37% for marked pancreatitis. Conclusion -Low level of fecal elastase 1 was associated with marked rather than mild chronic pancreatitis; however, it may be useful to indicate pancreatic exocrine insufficiency in asymptomatic former alcohol addicts. HEADINGS -Pancreatic elastase. Chronic pancreatitis. Alcoholics. Exocrine pancreatic insufficiency.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

Mattar

Lima

Costa

et al. 2014

Arq. Gastroenterol.

View full text Add to dashboard Cite

show abstract

“…Fecal elastase-1 test has a high predictive value for pancreatic insufficiency, but test lacks sensitivity for mild to moderate pancreatic exocrine insufficiency [12,13]. A majority of the chronic pancreatitis experts considered transabdominal US as useful diagnostic imaging technique to confirm the clinical suspicion of chronic pancreatitis.…”

Section: Discussionmentioning

confidence: 99%

A wide variation in diagnostic and therapeutic strategies in chronic pancreatitis: A Dutch national survey

et al. 2012

View full text Add to dashboard Cite

Context Optimal diagnostic and treatment modalities in chronic pancreatitis are controversial due to lack of evidence. Objective To evaluate current clinical practice, we conducted a survey with the primary objective to evaluate decisions regarding the diagnosis, management and screening in chronic pancreatitis. Design We developed a vignette survey. Setting We surveyed Dutch gastroenterologists, internists, gastrointestinal surgeons and an international expert panel. Results A total of 110 questionnaires (31% gastroenterologists, 39% internists and 20% gastrointestinal surgeons) were returned out of the 1,324 sent (response 8.3%). There was a wide variation in strategies regarding diagnosis, treatment and screening in chronic pancreatitis. As a diagnostic test, serum amylase is used frequently by internists, while gastroenterologists and experts often use fecal elastase. Most respondents preferred CT-scanning for diagnosis, while experts preferred transabdominal ultrasonography as an initial test. Respondents frequently use pancreatic enzymes for treatment of pain in chronic pancreatitis. The majority advised to perform an intervention (endoscopic or surgical) in case of morphological changes of the pancreatic duct. Conclusions The results of our survey identify important differences between physicians in diagnosis and management of chronic pancreatitis. This is often due to lack of evidence and consensus in literature. Certain wide-spread practices are in contrast with available evidence, and should be addressed by improved education and adherence to guidelines.

show abstract

“…Watery stools can cause an artificially low reading, but this can be remedied by centrifugation prior to analysis 63 . In addition, it is not sensitive in those with a mild to moderate exocrine insufficiency and could be affected by states of inflammation such as celiac disease 64 . Therefore, it is not able to be a definitive test of malabsorption or need for enzymes.…”

Section: The Pancreasmentioning

confidence: 99%

Pancreatic Surgery

Berry

2013

Nut in Clin Prac

View full text Add to dashboard Cite

Pancreatic surgery is a complicated procedure leaving postoperative patients with an altered gastrointestinal (GI) anatomy and a potential for further surgical complications such as leaks and fistulas. Beyond surgical complications, these patients are prone to delayed gastric emptying, fat malabsorption, and hyperglycemia, with early satiety and poor appetite further compromising nutrition status. Many of these patients are malnourished prior to this major surgical procedure, and significant weight loss is common postoperatively. Does this affect their outcome? There seems to be a lack of consensus in this patient population regarding how to optimize nutrition and limit potential deleterious effects of this surgery. It is important to first understand the underlying disease condition and the effects to the gland, different forms of surgery with subsequent GI alterations, and common surgical and digestive complications. Once this is reviewed, existing nutrition support literature will be explored in attempts to determine the best nutrition management in this patient population.

show abstract

Fecal Elastase: A Useful Test for Pancreatic Insufficiency?

Cited by 22 publications

References 18 publications

Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

Comparison of Fecal Elastase 1 for Exocrine Pancreatic Insufficiency Evaluation Between Ex-Alcoholics and Chronic Pancreatitis Patients

A wide variation in diagnostic and therapeutic strategies in chronic pancreatitis: A Dutch national survey

Pancreatic Surgery

Contact Info

Product

Resources

About