The Lundh test and faecal elastase 1 determination in chronic pancreatitis: A comparative study

A Rapid, Endoscopic Exocrine Pancreatic Function Test and the Lundh Test: A Comparative Study

“…Secretin may be a weak stimulus for pancreatic elastase secretion, and previously we found much higher concentrations of duodenal elastase after meal stimulation than in the present study [19] . So, the determination of secretin-stimulated elastase in the duodenal content seems less suited as pancreatic function testing.…”

“…In a study by Elphick and Kapur [20] , concentration of FE-1, correlated significantly with the clinical response to supplementation with pancreatic enzymes, suggesting ability of the test to predict EPI. We have previously found FE-1 concentrations to be a sensitive test for exocrine pancreatic function when the patients have prominent imaging findings suggestive of chronic pancreatitis [19] . The FE-1 test is simple, but in our view does not have the diagnostic sensitivity to distinguish between normal and minor REPF.…”

Using faecal elastase-1 to screen for chronic pancreatitis in patients admitted with acute pancreatitis

“…However, Lankisch et al concluded that [FE‐1] was not distinctly superior to faecal chymotrypsin estimation, particularly in mild or moderate forms of chronic pancreatitis 17 . Similar conclusions were drawn when comparing [FE‐1] to the direct Lundh test 18 .…”

Now that fecal elastase is available in the United States, should clinicians start using it?

“…If Löser et al [12] had used this system, they would probably have obtained lower sensitivity for fecal elastase 1 in their moderate group. Two recent studies compared the specificity and sensitivity of fecal elastase-1 estimation with those of the bentiromide test [24] and the Lundh test [25]. The first study cannot be used for evaluation of the indirect test because it was not compared with a direct pancreatic function test as the gold standard [24].…”

“…The first study cannot be used for evaluation of the indirect test because it was not compared with a direct pancreatic function test as the gold standard [24]. In the other study [25], two groups of patients with chronic pancreatitis were formed: one without or with only mild morphologic changes and one with moderate to marked morphologic changes according to the Cambridge classification [21,22]. With the Lundh test, another direct pancreatic function test, used as the reference, the sensitivity and specificity rates of fecal enzyme estimation were 33% and 87%, respectively, in the first group, and 95% and 50%, respectively, in the second group.…”