The pancreatic elastase 1 fecal test is used to diagnose insufficiencies of the pancreas that result in diseases such as:
- Cystic fibrosis
- Chronic pancreatitis
- Pancreatic cancer
- Inflammatory Bowel Disease
- Gallstones
- Diabetes, Type 1
- Shwachman-Diamond Syndrome
In many of these conditions, there is often diarrhea, weight loss, undigested food in the stool, and pain in the abdomen. If the condition continues for a longer period of time, then low bone density may be found.
This test is an excellent biomarker for how well the pancreas is working because the enzyme pancreatic elastase I is not broken down by what happens in the intestinal tract. The Elastase I protein is found concentrated in the stool, five times higher than what is found in pancreatic juice.
Normal Ranges for Pancreatic Elastase in ug/gram fecal matter:
Normal: >200 ug elastase/gram fecal matter
Severe pancreatic insufficiency: <100 ug elastase/gram fecal matter
Moderate pancreatic insufficiency: 100-200 ug elastase/gram fecal matter
Sources:
- https://www.labcorp.com/test-menu/32666/pancreatic-elastase-fecal
- https://www.gdx.net/product/pancreatic-elastase-test-stool
- https://www.childrensmn.org/references/lab/urinestool/pancreatic-elastase-stool.pdf
- Lam KW, Leeds J. How to manage: patient with a low faecal elastase. Frontline Gastroenterol. 2019 Nov 15;12(1):67-73. doi: 10.1136/flgastro-2018-101171. PMID: 33489070; PMCID: PMC7802491. [L]
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There are no problems recorded in medical literature for high levels of Pancreatic Elastase.
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A low Pancreatic Elastase marker in a gastrointestinal (GI) panel typically indicates exocrine pancreatic insufficiency (EPI), a condition where the pancreas does not produce sufficient digestive enzymes, specifically elastase, to properly break down food in the intestine. Pancreatic elastase is a key enzyme in the digestion of proteins and its deficiency can lead to malabsorption and malnutrition due to the inadequate breakdown of fats, proteins, and carbohydrates.
EPI can result from various underlying conditions, such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, or surgical removal of part or all of the pancreas. In the context of chronic pancreatitis, the progressive inflammation and fibrosis of the pancreas lead to the destruction of exocrine tissue responsible for enzyme production. Cystic fibrosis causes thick mucus to obstruct the pancreatic ducts, hindering enzyme release. Pancreatic cancer or surgeries like pancreatectomy can physically reduce or remove the tissue that produces these enzymes.
The primary treatment for EPI is pancreatic enzyme replacement therapy (PERT), which involves taking oral pancreatic enzyme supplements with meals and snacks. These supplements contain lipase, amylase, and protease, the enzymes necessary for the digestion of fats, carbohydrates, and proteins, respectively. The dosage of PERT is adjusted based on the severity of enzyme deficiency, dietary fat content, and individual patient response. Patients are often advised to follow a nutrient-rich, low-fat diet and may require fat-soluble vitamin supplements (vitamins A, D, E, and K) due to malabsorption.
Additionally, addressing the underlying cause of EPI is crucial. For instance, in chronic pancreatitis, managing pain, preventing flare-ups, and abstaining from alcohol can be important. In cystic fibrosis, specific treatments to manage the overall condition are necessary. Regular follow-ups and monitoring are essential to adjust treatments and manage potential complications such as diabetes mellitus, osteoporosis, or malnutrition-related conditions.
Overall, a low Pancreatic Elastase marker on a GI panel is a significant finding that requires comprehensive management encompassing enzyme replacement, dietary modifications, and treatment of the underlying cause.
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