Clinical Utility of Fecal Elastase 1 Test in Chronic Pancreatitis

Yoon, Yong Bum; Kim, Chung Yong; Kim, Yong Tae; Ryu, Ji Kon

Abstract

BACKGROUND AND AIMS: Elastase is a stable pancreatic enzyme in stool. The concentration of fecal elastase 1 is suggested to be a good marker of pancreatie exocrine function. The aims of this study were to evaluate the sensitivity and the specificity of the diagnostic method for chronic pancreatitis using the concentration of fecal elastase 1, the correlation between the concentration of fecal elastase 1 and the morphologic grade of chronic pancreatitis, and whether the measurement of the fecal elastase 1 concentration can differentiate chronic pancreatitis from acute pancreatitis or pancreatic cancer.
METHODS
Twenty eight healthy controls and 61 patients (12 patients with acute pancreatitis, 30 patients with chronic pancreatitis and 19 patients with pancreatic cancer) were included in this study. The degrees of chronic pancreatitis were classified by the Cambridge classification.
RESULTS
The mean values of fecal elastase 1 concentration were 894+/-644 ug/g stool in controls, 608+/-535 ug/g stool in patients with acute pancreatitis, 143+/-200 ug/g stool in patients with chronic pancreatitis and 97+/-124 ug/g stool in patients with pancreatic cancer. The mean values of fecal elastase 1 concenctration in the patients with chronic pancreatitis and pancreatic cancer were statistically lower than those in the control and patients with acute pancreatitis (p<0.05). With a cut-off value of 200 ug/g stool, the sensitivity for diagnosing the chronic pancreatitis was 0% for the equivocal, 33% for the mild, 80% for the moderate and 89% for the severe chronic pancreatitis, and 73% for all patients with chronic pancreatitis. In addition, the overall specificity was 92.9%.
CONCLUSIONS
Measurement of fecal elastase 1 concentration is a simple and sensitive test in patients with moderate to severe degree of chronic pancreatitis and seems to be useful for the differentiation of the acute and chronic pancreatitis.