Fecal Elastase-1 Concentrations Research Articles

Elastase-1 concentration in feces of term and preterm infants aged 0 – 4 months

Fecal elastase-1 concentration reflects exocrine pancreatic function. There have been some reports from Europe, but so far there has not been a report of fecal elastase-1 concentration in Indonesia, especially concerning infants. The aim of this study is to know the concentration of elastase-1 in feces of infants aged 1-120 days as a preliminary report of the study of the ontogeny of pancreatic elastase-1 in term and preterm infants. Fecal elastase-1 were measured from feces of 28 healthy preterm and 34 healthy term infants up to 120 days (4 month) of age. Elastase-1 concentration in infants less than 14 days of age fluctuated below 200 μg/gram feces. At the first day of life 80% preterm and 60% term infants had elastase-1 concentration less than 200 μg/gram feces, and by the age of 7 days 50% preterm and 33% term infants had elastase-1 concentration less than 200 μg/gram feces. After 14 days of age its concentration was more than 200 μg/gram feces, regardless of gestational age. This preliminary study corroborates supported the previous studies that the level of fecal elastase-1 reached normal level after 14 days. Future longitudinal study is needed to know elastase-1 concentration in infants less than 14 days. (Med J Indones 2003; 12: 69-72) Keywords: Fecal elastase-1, Infants, Enzyme-link immunosorbent assay

Longitudinal follow-up of exocrine pancreatic function in pancreatic sufficient cystic fibrosis patients using the fecal elastase-1 test.

A progressive decline in pancreatic function is possible in cystic fibrosis (CF) patients with exocrine pancreatic sufficiency. The secretin-cholecystokinin test is invasive and not acceptable as a repeatable procedure for children. Steatorrhea, conversely, has low sensitivity. Therefore, the aim of the present study was to evaluate the usefulness of the noninvasive fecal elastase-1 (E1) test for the longitudinal assessment of exocrine pancreatic function (EPF) in pancreatic-sufficient (PS) CF patients. One hundred eighty-four CF patients were included in the study. In all subjects, E1 concentrations and fecal fat excretion were measured. PS patients were followed for 5 years. At the beginning of the study, 35 (19.0%) CF patients were PS, and 32 (17.4%) had normal E1 concentrations. Longitudinal measurements of E1 concentrations in PS patients with CF demonstrated stable enzyme output in 27 and gradual decrease in 8. The decrease was rapid in five infant patients and gradual in three older patients. The decrease of E1 concentrations preceded the appearance of steatorrhea in all eight subjects. The decline of EPF in patients with CF appears more frequently during the first months and years of life. However, late PS to pancreatic-insufficient (PI) conversion is also possible. The appearance of maldigestion is preceded by the decrease of fecal E1 concentration. Thus, the fecal E1 test is a helpful screening tool for the longitudinal assessment of declining EPF in PS patients with CF to demonstrate pancreatic deterioration. In suspected patients, fecal fat excretion should be assessed.

Longitudinal Follow‐Up of Exocrine Pancreatic Function in Pancreatic Sufficient Cystic Fibrosis Patients Using the Fecal Elastase‐1 Test

ABSTRACTBackgroundA progressive decline in pancreatic function is possible in cystic fibrosis (CF) patients with exocrine pancreatic sufficiency. The secretin–cholecystokinin test is invasive and not acceptable as a repeatable procedure for children. Steatorrhea, conversely, has low sensitivity. Therefore, the aim of the present study was to evaluate the usefulness of the noninvasive fecal elastase‐1 (E1) test for the longitudinal assessment of exocrine pancreatic function (EPF) in pancreatic‐sufficient (PS) CF patients.MethodsOne hundred eighty‐four CF patients were included in the study. In all subjects, E1 concentrations and fecal fat excretion were measured. PS patients were followed for 5 years.ResultsAt the beginning of the study, 35 (19.0%) CF patients were PS, and 32 (17.4%) had normal E1 concentrations. Longitudinal measurements of E1 concentrations in PS patients with CF demonstrated stable enzyme output in 27 and gradual decrease in 8. The decrease was rapid in five infant patients and gradual in three older patients. The decrease of E1 concentrations preceded the appearance of steatorrhea in all eight subjects.ConclusionsThe decline of EPF in patients with CF appears more frequently during the first months and years of life. However, late PS to pancreatic‐insufficient (PI) conversion is also possible. The appearance of maldigestion is preceded by the decrease of fecal E1 concentration. Thus, the fecal E1 test is a helpful screening tool for the longitudinal assessment of declining EPF in PS patients with CF to demonstrate pancreatic deterioration. In suspected patients, fecal fat excretion should be assessed.

High Prevalence of Exocrine Pancreatic Insufficiency in Diabetes mellitus

Background: There have been numerous reports on pancreatic exocrine dysfunction in diabetes mellitus using either direct or indirect function tests. The measurement of fecal elastase 1 concentrations (FEC) has been used as a screening tool for exocrine pancreatic disease in different patient groups indicating a high prevalence of exocrine dysfunction in diabetic populations. In this study we had the opportunity to study more than 1,000 diabetic patients to confirm recent observations in smaller populations. Methods: FEC were measured by ELISA in 323 patients with type 1 and 697 type 2 diabetes mellitus. Subjects with a history of alcohol abuse, gastrointestinal surgery, cancer or inflammatory diseases were not included. Diabetes history and clinical data were recorded using a standard case report form. Findings: 1,021 patients (334 female, 687 male; mean age 50 years; mean diabetes duration 11 years; mean age at onset of diabetes 39 years) were studied. FEC was normal (>200 µg/g) in 59.3% and severely reduced (<100 µg/g) in 22.9%. There were significant differences between type 1 and type 2 patients as well as between insulin-treated and non-insulin-treated patients. Furthermore, there were weak associations between FEC and diabetes duration, age at onset of diabetes and body mass index, respectively. Interpretation: We could confirm that both type 1 and type 2 diabetic patients show pathological exocrine function in high prevalence. Exocrine insufficiency seems to be correlated to early onset of endocrine failure, long-lasting diabetes mellitus and low body mass index levels.

The Lundh Test and Faecal Elastase 1 Determination in Chronic Pancreatitis: A Comparative Study

Background/Aim: A reduced exocrine pancreatic function supports the diagnosis of chronic pancreatitis (CP) in symptomatic patients. A sensitive test for a reduced exocrine function is decisive, especially when morphological changes are missing. The aim of this study was to compare the indirect faecal elastase 1 (FE-1) test with the direct Lundh test in patients with and without definite diagnostic imaging findings. Methods: Eighty-nine patients with clinical signs suggesting CP or having an established diagnosis of CP had a Lundh test and an estimation of FE-1 performed. All patients underwent abdominal ultrasonography and/or computed tomography. Results: A significant correlation (r = 0.70, p < 0.02) was found between FE-1 and meal-stimulated intraduodenal lipase. Using the Lundh test as reference, the predictive values of a positive and negative FE-1 test were for all patients investigated 81 and 73%, respectively. Patients with equivocal imaging findings had lower predictive values (positive predictive value 57%; negative predictive value 71%) as compared with patients with moderate or marked imaging findings (positive predictive value 84%; negative predictive value 78%). Fair to moderate chance-corrected agreement was found between Lundh test and FE-1 concentration. Conclusions: In patient with imaging findings suggesting CP, FE-1 determination is a highly sensitive test for exocrine pancreatic function, but in patients with equivocal imaging findings, the predictive power of FE-1 limits the test to serve as a reliable diagnostic tool.

Inhibition of endogenous pancreatic enzyme secretion by oral pancreatic enzyme treatment.

The existence of a feedback mechanism for exocrine pancreatic secretion in humans is controversial. Exclusion of proteases from the duodenum stimulates exocrine pancreatic secretion. Conversely, addition of exogenous enzymes could reduce the enzyme secretion. Further investigation of the feedback mechanism should be performed under the most physiological conditions. In the present study we investigated exocrine pancreatic function by measuring fecal enzyme output in healthy volunteers consuming a normal diet, before and during a time course of exogenous pancreatic enzyme supplementation. Twenty-five healthy subjects (HS) were given two different doses (30 and 60 FIP proteases kg(-1) d(-1)) divided by the number of meals. In all subjects, fecal elastase-1 (E1) concentrations and chymotrypsin (ChT) activities were measured without and with enzyme supplements after 7 days of treatment. In eight subjects, E1 concentrations and ChT activities were measured daily for 10 consecutive days. The subjects were given a dose regimen of 100 FIP proteases kg(-1) d(-1)(divided by the number of meals) for the first 7 days. Oral pancreatic treatment dose-dependently inhibited endogenous pancreatic secretion measured with the use of E1 concentrations. In both regimen groups, the differences were statistically significant. The exogenous enzymes, which interfere with colorimetric method for ChT, dose-dependently increased ChT output. However, only the higher dose resulted in a statistically significant difference. In the subgroup of eight HS, time-dependent changes of fecal enzyme output occurred with a decrease of E1 concentrations and an increase of ChT activity from the second up to eighth or ninth day of the experiment. Exogenous applied pancreatic enzymes, dose- and time-dependently inhibited endogenous pancreatic secretion. The obtained results strongly support the existence of a protease mediated feedback mechanism in humans.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

How useful is fecal pancreatic elastase 1 as a marker of exocrine pancreatic disease?

Objectives: To evaluate the role of fecal elastase 1 (E1) as a marker of exocrine pancreatic insufficiency (PI). Study design: Fecal E1 was measured in patient groups with (1) failure to thrive but no pancreatic or intestinal disease (disease control patients); (2) PI; (3) pancreatic sufficiency; and (4) steatorrhea caused by a variety of intestinal diseases. Results: Fecal E1 in all disease control patients exceeded 200 μg/g stool. Only 1 (2%) of 50 patients with PI exceeded the minimum reference value of 100 μg/g stool. In contrast, 3 (11%) of 28 patients with pancreatic sufficiency (with Shwachman-Diamond syndrome) had fecal E1 concentrations <100 μg/g stool, as did 5 (20%) of 25 patients with steatorrhea from intestinal causes, all of whom had diluted feces caused by short gut. Conclusions: Fecal E1 is a useful noninvasive screening test of PI in childhood. A negative test (>100 μg/g stool) had 99% predictive value for ruling out PI. However, a positive test in those with short gut or Shwachman-Diamond syndrome must be interpreted with caution. (J Pediatr 2002;141:84-90)

Low fecal elastase-1 in type I diabetes mellitus.

Previous studies suggested impaired pancreatic exocrine function in type I diabetes patients, but have been limited by small or highly selected samples. Fecal elastase-1 has facilitated evaluation of pancreatic dysfunction in population-based studies. 112 type I diabetic patients (age +/- SD: 37 +/- 11 years; 47 % males; diabetes duration: 12.5 +/- 10.5 years) were consecutively selected from main regional diabetes centers in Essen, West-Germany. 116 non-diabetic control subjects, similar with respect to age and sex, were recruited from the same geographical region. Elastase-1 measurement was performed centrally by ELISA (ScheboTech, Germany). Elastase-1 concentrations in type I diabetic patients were significantly lower than in control subjects (median; inter-quartile range: diabetic patients: 227, 98-386 microgram/g stool; non-diabetic subjects: 544, 377-702 microgram/g stool) (p < 0.01). Elastase-1 < 100 microgram/g stool (E1 < 100) was found in 25.9 % of diabetic and 5.2 % of non-diabetic subjects, yielding an age-sex-adjusted prevalence Odds ratio (POR; 95 % CI) for diabetes and E1 < 100 of 6.9 (2.8-19.6). After adjusting for potential confounders (history of gastrointestinal diseases, smoking, alcohol consumption) the strong association remained (POR: 6.7; 2.7-19.2). Among patients with diabetes, E1 < 100 was associated with quality of glycemic control (HbA1c, change per 1 %: POR 1.5; 1.1-2.0), diabetes duration (per year: POR 1.1; 1.03-1.2), and age at diabetes onset (per age year: POR 1.1; 1.02-1.1). No association was found with history of gastrointestinal diseases, smoking, or alcohol consumption (current, life-time). Fecal elastase-1 concentrations were lower in type I diabetes patients compared to control subjects, indicating impaired pancreatic exocrine function. Low elastase-1 was associated with poor metabolic control and longer diabetes duration.

Both fecal elastase-1 and fecal chymotrypsin concentrations are decreased i vegetarians

Both fecal elastase-1 and fecal chymotrypsin concentrations are decreased i vegetarians

Both fecal elastase-1 and fecal chymotrypsin concentrations are decreased i vegetarians

Both fecal elastase-1 and fecal chymotrypsin concentrations are decreased i vegetarians

Pathological pancreatic exocrine function and duct morphology in patients with cholelithiasis.

Most authors claim alcohol consumption to be the only relevant reason for chronic pancreatitis. However, gallstones might cause this disease, as they do cause acute pancreatitis. In this study 91 gallstone patients and 94 age-matched controls were investigated concerning exocrine pancreatic function (fecal elastase-1 concentrations). Furthermore x-rays of 100 consecutive ERCP patients were evaluated for differences concerning pancreatic duct changes between patients with and without evidence of cholelithiasis. Pathological elastase 1 levels were more frequent in gallstone patients (30,8%) as compared to age-matched controls (19%). Symptoms such as upper abdominal pain, bloating, and fat intolerance were reported more often in gallstone patients. In ERCP of gallstone patients (N = 60), 77% were found to have chronic pancreatitis according to the Cambridge classification, while in nongallstone-patients (N = 32) 47% had chronic pancreatitis. In conclusion, according to these data a pathophysiological connection between gallstones and chronic pancreatitis appears to be probable.

Fecal Elastase-1 Determination: ?Gold Standard? of Indirect Pancreatic Function Tests?

Background: Tubeless pancreatic function tests measuring the content of elastase-1 and the activity of chymotrypsin in stool are used with different cut-off levels and with varying success in diagnosing functional impairment of the pancreas. The aim of our study was to re-evaluate the sensitivity and specificity of elastase-1 and chymotrypsin in stool in the assessment of exocrine pancreatic insufficiency. Methods: In 127 patients displaying clinical signs of malassimilation, the secretin-caerulein test ('gold standard'), fecal fat analysis, fecal chymotrypsin activity and fecal elastase-1 concentration were performed. Exocrine pancreatic insufficiency was graded, according to the results of the secretincaerulein test, into mild, moderate and severe. Chymotrypsin and elastase-1 in stool were estimated using two commercially available test kits. Fecal elastase-1 concentration of 200 and 100 µg/g stool and chymotrypsin activity of 6 and 3 U/g stool were used separately as cut-off levels for calculation. Results: 1) In 65 patients, a normal pancreatic function was found using the secretin-caerulein test. In 62 patients, an exocrine pancreatic insufficiency was found and classified into severe (n = 25), moderate (n = 14) and mild (n = 23). 2) The correlation between fecal elastase-1 and chymotrypsin with duodenal enzyme outputs of amylase, lipase, trypsin, chymotrypsin and elastase-1 ranged between 33% and 55% and 25% and 38%, respectively. 3) Using a cut-off of 200 µg elastase-1/g, stool sensitivities of fecal elastase-1 and fecal chymotrypsin (cut-off: 6 U/g) were 100% and 76%, respectively (P < 0.0001 and P < 0.001 respectively) in severe exocrine pancreatic insufficiency, 89% and 47% respectively (P < 0.001; P = 0.34, respectively) in moderate and 65% for both in mild pancreatic insufficiency. Specificities of elastase-1 and chymotrypsin in stool were 55% and 47%, respectively. 4) Elastase-1 based diagnostic provided a positive predictive value of 50% using a 'cut-off' 200 µg/g stool in a representative group of consecutively recruited patients with gastroenterological disorders. Conclusion: Determination of fecal elastase-1 is highly sensitive in the diagnosis of severe and moderate exocrine pancreatic insufficiency and is of significantly higher sensitivity than fecal chymotrypsin estimation. Specificity for both stool tests is low. Correlation between elastase-1 and chymotrypsin in stool and duodenal enzyme outputs is moderate. Neither test is suitable for screening, as they provide a pathologic result in roughly half of 'non-pancreas' patients.

Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus.

Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we investigated exocrine pancreatic function in 105 controls and 114 patients with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal elastase-1 concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold standard. Reduced faecal elastase-1 concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-1 concentrations did not correlate with alcohol consumption, diabetes duration or diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exocrine pancreatic function is also impaired in a high percentage in this group of patients. Pathogenetic concepts to explain these findings as consequences of diabetes complications or insulin deficiency are still under debate. Observations from autopsies and the data of the controls in this study suggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than believed so far.

Evaluation of fecal elastase-1 concentrations in various malabsorption conditions

Evaluation of fecal elastase-1 concentrations in various malabsorption conditions

Comparison of Fecal Elastase-1 Determination with the Secretin-Cholecystokinin Test in Patients with Cystic Fibrosis

Background: The secretin-cholecystokinin (CCK) test is the gold standard in the evaluation of exocrine pancreatic insufficiency. Because of its invasive character, it is of limited value in cystic fibrosis (CF) patients, especially in those with severe respiratory disease. The aim of the study was to evaluate the sensitivity of fecal elastase-1 in relation to the secretin-CCK test and quantitative fecal fat excretion in CF patients. Methods: The study comprised 28 patients (11 females and 17 males) aged 4 to 20 years. In all patients the secretin-CCK test and determination of fecal elastase-1 concentration (with enzyme-linked immunosorbent assay) and fecal fat excretion were performed. Results

47 SENSITIVITY AND SPECIFICITY OF FECAL ELASTASE 1 IN CHILDREN: COMPARISON WITH THE SEKRETIN-PANCREOZYMIN-TEST

The determination of fecal concentration of pancreatic elastase 1 (E1) has recently been described as a valuable parameter for estimation of exocrine pancreatic function (Scheefers-Borchel U et al. Lab med 1992;16:427). The aim of our study was the comparison of the E1 concentration in feces with the results of sekretin-pancreozymin-test in CF-patients. Material and Methods: Sensitivity of fecal E1 concentration was determined in 16 CF-patients (median of age 17.3 yr) on pancreatic enzyme replacement therapy. Specificity was assessed in 23 healthy children (median of age 5.7 yr). Fecal E1 was determined with an ELISA based on two monoclonal antibodies against human Elastase 1 (Schebo•Tech GmbH, Wettenberg, Germany). Aliquots of a homogenized 24h-stool-collection were tested. Pancreatic function was classified according to fecal E1 concentration as follows: Table Results and conclusion: According to secretin-pancreozymin-test 15 of the 16 investigated CF-patients had a severe pancreatic insufficiency and only 1 patient was moderately insufficient. The determination of fecal E1 concentration had a sensitivity to (severe) pancreatic insufficiency of 100% and a specificity of 96%. E1 determination in stool seems to be a more sensitive and specific test for pancreatic insufficiency than other indirect tube-less tests. Moreover, pancreatic function can be assessed without interruption of pancreatic enzyme therapy.