Fecal pancreatic elastase-1 levels in older individuals without known gastrointestinal diseases or diabetes mellitus

Abstract

BackgroundStructural changes occur in the pancreas as a part of the natural aging process. With aging, also the incidence of maldigestive symptoms and malnutrition increases, raising the possibility that these might be caused at least in part by inadequate pancreatic enzyme secretion due to degenerative processes and damage of the gland. Fecal elastase-1 is a good marker of pancreatic exocrine secretion. The aim of this study was to investigate the fecal elastase-1 levels among over 60 years old Finnish and Polish healthy individuals without any special diet, known gastrointestinal disease, surgery or diabetes mellitus.MethodsA total of 159 patients participated in this cross-sectional study. 106 older individuals (aged 60-92 years) were recruited from outpatient clinics and elderly homes. They were divided to three age groups: 60-69 years old (n = 31); 70-79 years old (n = 38) and over 80 years old (n = 37). 53 young subjects (20-28 years old) were investigated as controls. Inclusion criteria were age over 60 years, normal status and competence. Exclusion criteria were any special diet, diabetes mellitus, any known gastrointestinal disease or prior gastrointestinal surgery. Fecal elastase-1 concentration was measured from stool samples with an ELISA that uses two monoclonal antibodies against different epitopes of human elastase-1.ResultsFecal elastase-1 concentrations correlated negatively with age (Pearson r = -0,3531, P < 0.001) and were significantly lower among subjects over 70 years old compared to controls (controls vs. 70-79 years old and controls vs. over 80 years old, both P < 0.001). Among the over 60 years old subjects, the fecal elastase-1 concentrations were below the cut off level of 200 μg/g in 23 of 106 (21.7%) individuals [mean 112 (86-138) μg/g] indicating pancreatic exocrine insufficiency. Of those, 9 subjects had fecal elastase-1 level below 100 μg/g as a marker of severe pancreatic insufficiency.ConclusionIn our study one fifth of healthy older individuals without any gastrointestinal disorder, surgery or diabetes mellitus suffer from pancreatic exocrine insufficiency and might benefit from enzyme supplementation therapy.

Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufficiency? A Dual Centre UK Study

“…Similar rates of PEI were detected in this study by case finding compared to existing studies (13.1% <200µg/g, 5.4% 100-200µg/g, 7.6% <100µg/g) [7,8]. This supports the hypothesis that PEI is common in gastroenterology practice and clinicians should have a low threshold for checking FEL-1 in patients presenting with symptoms other than diarrhoea.…”

Pancreatic exocrine function in patients with diabetes

“…In our cohort, the proportions of patients with decreased elastase-1 concentration were comparable to those published in the literature [2,11,12,14,20,21]. Age at test was not associated with declining elastase, which is at odds with what has been published in patients without known gastrointestinal disease or diabetes [22]. Elastase-1 concentration was higher (data not shown) and the proportion of patients with altered tests was lower in patients with Type 1 diabetes or patients with Type 2 diabetes than in 47 patients with Type 3 diabetes.…”

American Pancreatic Association Practice Guidelines in Chronic Pancreatitis

“…Classic false-positives fecal elastase measurements (low levels) occur in small bowel bacterial overgrowth and watery stool. (129, 130) Conversely, classic false-negative serum trypsin measurements (normal/high levels) occur when performed in the setting of acute pancreatic inflammation. (131) In the absence of other supporting evidence, intermediate indirect pancreatic function test results (monoclonal fecal elastase 50–200μg/dL, or trypsin 20–29pg/dL by RIA) should be interpreted with caution when used to diagnose chronic pancreatitis.…”