Faecal elastase: testing for pancreatic exocrine insufficiency

Traditionally, the existence of pancreatic exocrine insufficiency (PEI) has most commonly been recognised in patients with cystic fibrosis and chronic pancreatitis, and the pancreatic elastase-1 stool test (faecal elastase) is incorporated in relevant UK guidelines from the Cystic Fibrosis Trust and British Society of Gastroenterology (BSG), respectively. Now, however, it is increasingly recognised that PEI can occur in the context of a range of different diseases including diabetes, coeliac disease, liver disease, and in some patients diagnosed with, for example, irritable bowel syndrome (IBS) or human immunodeficiency virus (HIV) infection. This has been covered in some detail in presentations given at the annual ‘Focus’ meetings of The Association for Clinical Biochemistry and Laboratory Medicine in 2012 and 2013.1,2 

In 2011, Leeds et al.3 reviewed the role of faecal elastase-1 in the detection of exocrine pancreatic disease and highlighted a number of key points. These were that exocrine pancreatic disease is more common than generally perceived, it may masquerade as other conditions leading to misdiagnosis, and exocrine pancreatic insufficiency may occur as part of a number of diseases with gastrointestinal involvement. The authors also suggested that more research is required into the benefits of pancreatic enzyme supplementation in many diseases related to exocrine pancreatic insufficiency.

The review by Leeds et al. included a PubMed literature search, performed in November 2010, for all available full-text English articles published with the search term ‘fecal elastase’ alone or in combination with ‘diabetes’, ‘celiac disease’, ‘HIV’, ‘irritable bowel syndrome’, ‘inflammatory bowel disease’ and ‘liver disease’, and was supported by 132 references.