High Levels Pancreatic Elastase In Stool


Why Is Epi Hard To Diagnose

Fecal Elastase Test | Stool Elastase Test | Pancreatic Exocrine Insufficiency |

When you have exocrine pancreatic insufficiency , you probably know your body doesnât feel right. Still, itâs not always easy for doctors to diagnose your condition.

The classic symptoms of EPI — weight loss, greasy and foul-smelling stools that float or are tough to flush, stomach cramps, and diarrhea — mimic the telltale signs of many other digestive diseases. You might even have one of those diseases along with EPI, like Crohnâs or celiac disease. That makes it hard for doctors to know exactly which condition is causing you trouble. To add to the confusion, not everyone with EPI has the same classic symptoms. Other warning signs can be too subtle for you to notice.

To figure out whatâs going on, your doctor will use tests to see how many nutrients your body is absorbing from food. Hereâs a rundown of the tests they might use.

Blood work. Your doctor will take a sample of your blood and send it to a lab to check it for anemia, a condition in which your body doesnât have enough healthy red blood cells. The lab will also test your blood for vitamin B12, iron, and folate. If the levels are too low, that can mean EPI is keeping your body from absorbing these nutrients.

The lab might also look for a chemical your pancreas makes to help with digestion called trypsinogen. A level thatâs too high is a sign of a problem.

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Elastase And Phospholipase A2

Pancreatic elastase is a form of elastase and a subfamily of serine proteases , member 3B , that hydrolyze many proteins in addition to elastin. Human pancreatic elastase-1 is quite stable and remains undegraded during intestinal transit. Therefore its concentration in feces reflects exocrine pancreatic function. During an inflammation of the pancreas, E1 is released into the bloodstream. Thus the quantification of pancreatic elastase-1 in serum and feces allows diagnosis or exclusion of acute pancreatitis . Urinary excretion of elastase-1 has been shown to increase in all patients with chronic pancreatic disease regardless of the neoplastic or inflammatory nature of the disease . Unfortunately, determination of elastase-1 does not provide any additional advantage over the combination of lipase and amylase for the diagnosis of acute pancreatitis and may not be a specific biomarker candidate.

Qianyu Li, … Yalei Dai, in, 2021

Research Design And Methods

We studied 37 consecutive type 1 diabetic patients and performed follow-up at the outpatient clinic of our diabetes unit . Diabetes duration was 10.4 ± 1.3 years, BMI 23.9 ± 0.6 kg/m2, caloric intake 2,047 ± 71 kcal/day, fasting plasma glucose 8.76 ± 0.40 mmol/l, C-peptide 0.30 ± 0.07 ng/ml, and HbA1c 8.1 ± 0.24%. A total of 20 healthy subjects, matched for age, sex, BMI, and daily caloric intake, were used as control subjects . Patients were on steady metabolic control, presented a stable body weight in the previous 6 months, did not report a history or symptoms of gastrointestinal disease, and tested negative for antibodies to gliadin and endomysium. They were on a normocaloric diet with a carbohydrate content accounting for 5560% of calories, with restriction of simple sugars, a protein content of 1 g/kg body wt, and a lipid content of 2530% of total calories. Subjects received three premeal rapid insulin injections and one bedtime intermediate insulin injection. Two patients were macroalbuminuric , and six were microalbuminuric seven subjects had background and two had preproliferative retinopathy.

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What Exactly Is Pancreatic Insufficiency

When the pancreas is healthy and functioning normally, it produces several enzymes . These enzymes are secreted into the small intestine, where they work together to digest food. In individuals with pancreatic exocrine insufficiency, the pancreas doesnt make enough of these enzymes to adequately break down food into absorbable components. This can lead to serious nutritional deficiencies.

In adults, pancreatic insufficiency is often a sign of chronic pancreatitis. Pancreatitis is an inflammation of the pancreas. Chronic pancreatitis is a long-lasting condition that tends to get worse over time. It can lead to permanent damage of the pancreas. Acute pancreatitis, another form of the disease, is a short-term condition. It is usually diagnosed with blood and/or imaging tests, rather than a stool elastase test.

Pancreatic Elastase A Key Biomarker

An Unusual Cause of Watery Diarrhea

Pancreatic elastase is a protein-digesting enzyme produced exclusively by the pancreas. It is released into the small intestine, where it is activated by mixing with another protein enzyme, trypsin. Pancreatic elastase does not get degraded when it travels through the intestinal tract, and if there is any inflammation of the pancreas, this enzyme gets released into the bloodstream.

Because it is an exclusive biomarker of pancreas functionality, pancreatic elastase, in either blood serum or stool tests, can show when there is inflammation of the pancreas or a reduction in pancreas functionality .

If left unchecked, pancreatic enzyme deficiencies can result in chronic pancreatitis this can then lead to a more serious condition known as EPI . This is a significant deficiency in pancreatic enzymes, especially relating to fat malabsorption .

Symptoms of EPI can range from general gut disturbances such as gas and bloating, to pain in the stomach and/or bones, to steatorrhea . Some 20 percent of people with chronic pancreatitis will develop EPI over time.

We can test for low levels of pancreatic elastase in a simple stool test .

Low levels of pancreatic elastase can be associated with:

  • Suppressed pancreatic function
  • Blood in the urine and/or stool
  • Heavy menstrual periods
  • Excessive bleeding from a cut or wound

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Looking For Reference Ranges

You may be able to find your test results on your laboratorys website or patient portal. However, you are currently at Testing.com. You may have been directed here by your labs website in order to provide you with background information about the test you had performed. You will need to return to your labs website or portal, or contact your healthcare practitioner in order to obtain your test results.

Testing.com is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test to obtain the reference range.

For more information, please read the article Reference Ranges and What They Mean.

What Causes Pancreatic Insufficiency

Pancreatic insufficiency can be caused by regular bouts of acute pancreatitis or by chronic pancreatitis. It is less frequently but sometimes associated with pancreatic cancer. Other causes of insufficiency may include celiac disease, Crohn disease, autoimmune pancreatitis , Zollinger-Ellison syndrome, and some surgical procedures that can lead to a decrease in digestive system or pancreatic function.

In children, pancreatic insufficiency is most frequently associated with cystic fibrosis or Shwachman-Diamond syndrome . SDS is the second most common cause of inherited pancreatic insufficiency, after CF. All those with SDS have some degree of pancreatic insufficiency beginning in infancy.

Additionally, people who are carriers of one mutated copy of the CFTR gene, the gene typically responsible for cystic fibrosis, may have pancreatic insufficiency and experience the associated signs and symptoms.

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Use In Diagnostic Tests

Human pancreatic elastase 1 remains undegraded during intestinal transit. Therefore, its concentration in feces reflects exocrine pancreatic function. During an inflammation of the pancreas, E1 is released into the bloodstream. Thus the quantification of pancreatic elastase 1 in serum allows diagnosis or exclusion of acute pancreatitis.

Main indications:

  • Diagnosis/exclusion of exocrine pancreatic insufficiency caused by e.g. Chronic Pancreatitis, Cystic Fibrosis, Diabetes Mellitus, Cholelithiasis , “Failure to Thrive”, Pancreatic Cancer, Papillary Stenosis
  • Follow-up monitoring of patients with mild or moderate pancreatic insufficiency
  • Diagnosis/exclusion of pancreatic involvement in association with gastrointestinal symptoms, abdominal pain or osteoporosis, for example.

Method of detection:

  • Sandwich ELISA with two monoclonal antibodies highly specific for human pancreatic elastase 1
  • The ELISA kit is based on a microtiter plate with 12 breakable single strips x 8 wells suitable for up to 42 samples in duplicate

Reference concentration to interpret Pancreatic Elastase results:For adults and children after the first month of life

  • Values > 200 μg elastase/g stool indicate normal exocrine pancreatic function
  • Values of 100-200 μg elastase/g stool suggest mild to moderate pancreatic insuffiency
  • Values < 100 μg elastase/g stool indicate exocrine pancreatic insufficiency.

How Is Exocrine Pancreatic Insufficiency Diagnosed

Stool Tests for Gastrointestinal Disorders Part 3: Fecal Elastase-1 of Pancreatic Function

Many digestive problems cause symptoms similar to EPI. Your healthcare provider may suspect EPI if you have a condition that affects your pancreas.

You may get one or more of these pancreas function tests:

  • Fecal elastase test to check stool for the presence of the elastase enzyme that helps digest proteins. Little elastase can indicate EPI.
  • Fecal fat test to measure the amount of fat in stool. A high fat volume may be a sign of EPI.
  • Secretin pancreatic function test to test how the pancreas responds to secretin, a hormone that triggers the release of digestive enzymes. For the test, you receive secretin through an intravenous line. Your provider uses endoscopic ultrasound to collect fluid and test it for enzymes.

You may also get a CT scan, abdominal ultrasound or other imaging tests. These tests can spot pancreas problems that can lead to EPI.

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Testing For Pancreatic Enzyme Deficiencies

The symptoms listed above are usually the clearest initial clue that you may be experiencing fat digestion issues. And the timing of symptoms, such as when fullness, bloating and indigestion occur, can help shed light on whether you have pancreatic insufficiency or another issue, such as low stomach acid.

Stomach acid issues will start while youre still at the dinner table, when you feel the need to unbutton your pants just after eating! Pancreatic insufficiency, on the other hand, will more likely hit two to four hours later, or maybe even later in the evening, hours after a meal.

Another heads-up symptom is vitamin D deficiency. If you take a vitamin D lab test after supplementing with vitamin D, but still see results indicating a deficiency, that often means there is a fat malabsorption issue to address. It could point to gallbladder issues and/or pancreatic insufficiency.

Once you identify fat malabsorption symptoms, you may want to simply try taking some digestive enzymes to see if you gain relief. While there are six types of digestive enzymes available, Id suggest starting with two that focus particularly on fat digestion: Pancreatic Enzymes Plus and Liver & Gallbladder Support. In many cases, Ive seen issues relating to pancreatic insufficiency resolve in a few weeks to a few months, just in taking enzyme support. .

Ask A Laboratory Scientist

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Enzymatic Digestion Of Insoluble Elastin

The most widely studied elastases, human neutrophil elastase and pancreatic elastase , belong to the serine proteinase family of enzymes. Neutrophil elastase is found in the azurophil granules of polymorphonuclear leukocytes and is essential for phagocytosis and defense against infection. Pancreatic elastase is stored as an inactive zymogen in the pancreas and is secreted into the intestine where it is activated by other digestive enzymes. Both enzymes cleave peptide bonds on the carboxyl-terminal side of amino acids with a small alkyl side chain, although HLE prefers amino acids with longer aliphatic chains at this position. Other enzymes that degrade elastin include bacterial elastases belonging to the family of metalloproteinases that require Zn2 + atoms for activity. In contrast to the serine proteinases, bacterial metalloelastases cleave peptide bonds on the amino-terminal side of the amino acid that determines specificity. Elastases from Bacillus thermoproteolyticus and Streptomyces fradiae are four and eight times more active than PE, respectively, making them some of the most potent elastolytic proteinases reported . Several matrix metalloproteinases secreted by mammalian cells also have elastolytic activity. These include MMP-2, -3, -7, -9, -10, and -12 .

5.3.1Elastase digestion protocol

P.J. Stone, S.M. Morris, in, 2006

Fat Digestion And Nutrient Absorption

Detection of human elastase isoforms by the ScheBo Pancreatic Elastase ...

Our pancreas works, along with our liver and gallbladder, to digest and absorb fats. If weve eaten a fatty meal, concentrated bile is released from the gallbladder into a duct leading to the small intestine. The biles job is to break down fats into tiny globules that can be more easily dissolved.

At the same time, the pancreas releases its own pancreatic enzymes and pancreatic juice, mixing with the bile and tiny globules of fat. The bile and pancreatic secretions work together to dissolve fats in the watery small intestine. Pancreatic juices also help with digesting protein and carbohydrates, as well as neutralizing all of the digesting food . All of these actions allow nutrients to be more readily extracted and absorbed .

Without adequate bile and pancreatic enzymes, many essential nutrients can be lost and excreted with other wastes in the stool, leading to nutrient deficiencies such as fatty-acid deficiency. Additionally, our foods will not be fully digested and may linger too long in the digestive tract. This can result in our developing food sensitivities, small intestinal bacterial overgrowth , and other issues, which well talk about.

People who also have low stomach acid may also lose the ability to fend off harmful microorganisms in the gut, such as H. pylori a very common infection seen in Hashimotos.

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How Is Exocrine Pancreatic Insufficiency Managed Or Treated

EPI is a lifelong condition. Treatments focus on getting your body the nutrients it needs to maintain good health. Treatments include:

  • Pancreatic enzyme replacement therapy: This prescription medication is a substitute for the missing digestive enzymes. You take PERT with meals to help your body break down nutrients in food.
  • High-calorie, high-fat diet: Its important to get enough calories and fat with your meals. Fat helps your body absorb nutrients. You may benefit from working with a dietitian.
  • Vitamins: You may need to take prescription vitamins to help your body maintain healthy nutrient levels. Your provider may prescribe vitamins A, D, E and K. People with EPI have a harder time absorbing these fat-soluble nutrients from food.

Is There Anything Else I Need To Know About A Stool Elastase Test

If you are diagnosed with chronic pancreatitis, there are treatments that can help manage your condition. Treatment usually includes dietary changes, medicines to manage pain, and/or pancreatic enzyme supplements you can take with each meal. Your provider may also recommend that you give up drinking alcohol and smoking.

If your child was diagnosed with cystic fibrosis or Shwachman-Diamond syndrome, talk to your child’s provider about treatment options.

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Faecal Pancreatic Elastase Test


The faecal pancreatic elastase test, or more commonly known as the stool elastase test, is used to access the functioning of the pancreas. This particular test detects the levels of the enzyme elastase in the stool.

The exocrine part of the pancreas produces the elastase enzyme. This enzyme is released into the small intestine to help the breakdown of macromolecules of food e.g. proteins

Elastase passes down the digestive tract and is eliminated via the faeces. Normal levels of elastase in the stool indicate an optimally working pancreas. However, abnormal values of elastase point towards a pancreatic abnormality.


There are a number of conditions that can lead to disruptions in the stool elastase levels including:

Pancreatic Insufficiency

As the name indicates, exocrine pancreatic insufficiency is a condition characterised by the underperformance of the pancreas . The lower than normal level of the digestive enzyme by the pancreas hinders the process of digestion and therefore, malabsorption ensues.

Pancreatic damage may be the outcome of blockage of pancreatic ducts, recurrent inflammation of the pancreas, previous pancreatic surgery, etc. Patients suffering from cystic fibrosis, chronic pancreatitis , and Shwachman-Diamond syndrome, are at great risk of developing EPI. It can also be linked to pancreatic cancer.

Faecal Pancreatic elastase level is a marker for pancreatic insufficiency.


Symptoms Of Pancreatic Exocrine Insufficiency

Surgery 608 Pancreatic function test lipase CRP secretin elastase how to check pancreas working

The most common symptom of PEI is fatty stools . Steatorrhea occurs when the digestive system is unable to absorb dietary fats. Instead, these fats pass through the intestinal tract with waste products. The stools tend to be oily, large, pale, very foul-smelling, and often float in toilet water and stay in the toilet bowl, even after flushing. Individuals with steatorrhea sometimes experience fecal incontinence or oily leakage. Intestinal gas and bloating can also occur from the fermentation of undigested food in the colon.

Many individuals with PEI will experience nutritional deficiencies, especially of fat-soluble vitamins such as A, D, E, and K, since they are not taking in enough fats to help absorb these vitamins. PEI can also cause weight loss, because patients do not get enough calories from the food they eat. Weight loss is more common in those who have PEI in addition to a digestive disease, such as Crohns disease. In children, these factors can also result in a failure to thrive.

Some symptoms of nutrient malabsorption, and their typical causes, include:

  • bleeding disorders, including bleeding easily, problems forming clots, bleeding under the skin, and blood in the feces or urine

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