Elastase is an enzyme produced in the pancreas and released into the duodenum. There it survives intestinal transit unharmed and is an important parameter for exocrine pancreatic function. The active digestive enzyme cleaves elastin (structural protein).
Fecal elastase (synonym: stool elastase) is a specific marker of pancreatic insufficiency.
The procedure
Material needed
- Stool → at least three samples should be taken
- Duodenal juice
Preparation of the patient
- Not necessary
Disruptive factors
- Very thin or liquid stool (dilution effect).
Normal values
| Standard values in μg/g | > 200 |
Indications
- Suspected exocrine pancreatic insufficiency (pancreatic dysfunction associated with inadequate production of digestive enzymes)
- Suspected acute/chronic pancreatitis (inflammation of the pancreas).
- Suspicion of cystic fibrosis (cystic fibrosis).
- Suspicion of ulcerative colitis – chronic inflammatory disease of the mucosa of the colon (large intestine) or rectum (rectum).
- Unclear abdominal pain in children
Interpretation
Interpretation of lowered values
- Exocrine pancreatic insufficiency
- Pancreatic carcinoma (cancer of the pancreas)
- Stones in the pancreas
- Hemochromatosis (iron storage disease)
- Cystic fibrosis
Further notes
- Fecal elastase testing has a sensitivity of approximately 95% for the diagnosis of exocrine pancreatic insufficiency (EPI) and more easily detects moderate and mild cases compared with other methods.Limits:
- Moderate exocrine insufficiency: ≤ 200 µg/g.
- Severe exocrine insufficiency: ≤ 100 µg/g
Elastase levels > 500 µg/g virtually exclude exocrine dysfunction. Note: Diarrhea not due to exocrine pancreatic insufficiency may result in falsely low elastase levels (dilution effect
- Fecal elastase determination can be performed even with ongoing enzyme substitution because antibodies specifically bind human elastase.
- In addition, elastase in serum should also be determined.
