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

Turner, Richard; McDermott, Robyn

doi:10.1080/13651820500539602

Cited by 8 publications

(6 citation statements)

References 19 publications

(22 reference statements)

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“…Its concentration in human feces is about 5-to 6-fold higher than in pancreatic-duodenal juice. It is also stable in stool samples for up to 1 week at room temperature 13 and is not degraded during a long-term storage at −20 C. 16,17 The good stability during storage at freezer was also suggested by our observation that elastase concentrations did not differ Our results are in line with previous observations showing that the exocrine pancreas of type 1 diabetic patients is affected by an inflammatory process and fibrosis 18 and that this process can start already before type 1 diabetes is diagnosed. Recent studies have also shown that the size of the whole organ is decreased both in patients and in autoantibody-positive prediabetic individuals.…”

Section: Discussionmentioning

confidence: 99%

Exocrine pancreas function decreases during the progression of the beta‐cell damaging process in young prediabetic children

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Exocrine pancreas function decreases during the progression of the beta‐cell damaging process in young prediabetic children

et al. 2017

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“…Fecal elastase‐1 testing is used commonly in the clinical setting and is simple to perform. In chronic EPI, its sensitivity has been reported as 79.5% with a specificity of 98% in detecting EPI in patients with pancreatitis . There is debate between institutions over the normal range, but the commonly accepted diagnostic result is a fecal elastase‐1 greater than 200 μg/g.…”

Section: Introductionmentioning

confidence: 99%

Exocrine pancreatic insufficiency following esophagectomy

et al. 2012

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Weight loss following esophagectomy is a management challenge for all patients. It is multifactorial with contributing factors including loss of gastric reservoir, rapid small bowel transit, malabsorption, and adjuvant chemotherapy. The development of a postoperative malabsorption syndrome, as a result of exocrine pancreatic insufficiency (EPI), is recognized in a subgroup of patients following gastrectomy. This has not previously been documented following esophageal resection. EPI can result in symptoms of flatulence, diarrhea, steatorrhea, vitamin deficiencies, and weight loss. It therefore has the potential to pose a significant level of morbidity in postoperative patients. There is some evidence that patients with proven EPI (fecal elastase-1 < 200 μg/g) may benefit from a trial of pancreatic enzyme replacement therapy (PERT). We observed symptoms compatible with EPI in a subgroup of patients following esophagectomy. We hypothesized that this was contributing to malabsorption and malnutrition in these patients. To investigate this, fecal elastase-1 was measured in postoperative patients, and in those with proven EPI, a trial of PERT was commenced in combination with specialist dietary education. At routine postoperative follow-up, which included assessment by a specialist dietitian, those patients with symptoms suggestive of malabsorption were given the opportunity to have their fecal elastase-1 measured. PERT was then offered to patients with fecal elastase-1 less than 200 μg/g (EPI) as well as those in the 200-500 μg/g range (mild EPI) with more severe symptoms. Fecal elastase-1 was measured in 63 patients between June 2009 and January 2011 at a median of 4 months (range 1-42) following surgery. Ten patients had fecal elastase-1 less than 200 μg/g, and all had failed to maintain preoperative weight. All accepted a trial of PERT. Nine (90%) had symptomatic improvement, and seven (70%) increased their weight. Thirty-nine patients had a fecal elastase-1 in the 200-500 μg/g range. Twelve were given a trial of PERT based on level of symptoms, five (42%) reported an improvement in symptoms, but only two (17%) gained weight. Our early results support the observation that EPI is a factor contributing to postoperative morbidity in patients recovering from esophagectomy and that these patients can benefit from a trial of PERT. Our study has limitations, and a formal trial is required to evaluate the impact of EPI and PERT following esophagectomy. Currently, our practice is to measure fecal elastase-1 in any patient with unexplained weight loss or symptoms of malabsorption. In patients with proven EPI or those who are symptomatic with mild EPI, a trial of PERT should be offered and symptoms reassessed.

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“…Adiposity was measured as body mass index (BMI), waist circumference (WC) and waist‐to‐hips ratio (WHR) (dichotomized to <1 and ≥1). Co‐existing CP was defined if at least one of the following criteria were fulfilled: four or more previous admissions for acute pancreatitis, a history of continuous or recurrent epigastric pain, malabsorption (steatorrhoea), radiological abnormalities (calculi, parenchymal atrophy, ductal dilatation, non‐acute pseudocysts) and faecal elastase‐1 concentration [FE‐1] less than 200 μg/g where the acute attack was not severe …”

Section: Methodsmentioning

confidence: 99%

Clinical predictors of severe acute pancreatitis: value-adding the view from the end of the bed

Turner

McDermott

2013

ANZ J Surg

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

Abstract: [FE-1] is an accurate screening tool for underlying chronic exocrine insufficiency when taken in the course of a hospital admission for mild acute pancreatitis.

Cited by 8 publications

References 19 publications

Exocrine pancreas function decreases during the progression of the beta‐cell damaging process in young prediabetic children

Exocrine pancreas function decreases during the progression of the beta‐cell damaging process in young prediabetic children

Exocrine pancreatic insufficiency following esophagectomy

Clinical predictors of severe acute pancreatitis: value-adding the view from the end of the bed

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