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

Summary

The fecal elastase test is essential for diagnosing exocrine pancreatic insufficiency, a condition where the pancreas fails to produce enough digestive enzymes, leading to symptoms like malnutrition, bloating, and oily stools. Chronic pancreatitis is the most common cause, although cystic fibrosis and other rare conditions can also contribute. While there are alternative tests, such as serum trypsinogen and stool fat analysis, fecal elastase remains the most reliable. The test helps identify nutrient absorption issues and guide treatment to prevent complications like vitamin deficiencies and weight loss.

Takeaways

• 😀 The fecal elastase test is used to diagnose exocrine pancreatic insufficiency (EPI), a condition where the pancreas doesn't produce enough digestive enzymes.
• 😀 Exocrine pancreatic insufficiency leads to malnutrition, weight loss, bloating, and fatty stools (steatorrhea) due to poor digestion.
• 😀 The pancreas has two main functions: endocrine (producing insulin for blood sugar regulation) and exocrine (producing digestive enzymes for food digestion).
• 😀 Chronic pancreatitis is the most common cause of pancreatic exocrine insufficiency, but other causes include pancreatic surgery, cystic fibrosis, and hemochromatosis.
• 😀 Symptoms of pancreatic insufficiency include bloating, diarrhea, oily stools, and difficulty absorbing fat, which can lead to malnutrition.
• 😀 Steatorrhea, a key symptom of EPI, involves foul-smelling stools that may contain oil droplets, and can be hard to flush due to unabsorbed fat.
• 😀 A fecal elastase level below 200 micrograms per gram of stool indicates pancreatic insufficiency.
• 😀 Serum trypsinogen is a blood test for pancreatic insufficiency, but it is less sensitive than the fecal elastase test.
• 😀 The Sudan stain is another test that detects fat globules in stool, helping to identify malabsorption of fats.
• 😀 The 72-hour fecal fat test is a comprehensive but inconvenient test that requires stool collection over three days and a high-fat diet to assess fat absorption.

Q & A

What is exocrine pancreatic insufficiency (EPI)?

Exocrine pancreatic insufficiency (EPI) occurs when the pancreas does not produce enough digestive enzymes to properly break down food, leading to malnutrition, weight loss, bloating, and fat in the stools.

What is the main difference between the pancreas's endocrine and exocrine functions?

The pancreas has two main functions: the endocrine function involves the production of insulin, which regulates blood sugar, while the exocrine function involves the release of digestive enzymes that aid in food digestion.

What are the most common symptoms of exocrine pancreatic insufficiency?

Common symptoms of EPI include mild bloating, severe diarrhea, storrhea (fatty, foul-smelling stools), difficulty flushing stools due to oil droplets, weight loss, and malnutrition.

How does a low level of fecal elastase indicate exocrine pancreatic insufficiency?

A low fecal elastase level, specifically less than 200 micrograms per gram of stool, indicates insufficient production of digestive enzymes, which is a key characteristic of exocrine pancreatic insufficiency.

What are the primary causes of exocrine pancreatic insufficiency?

The most common cause of EPI is chronic pancreatitis. Other causes include pancreatic surgery or resection, cystic fibrosis, hemochromatosis, genetic factors, and certain rare conditions.

Why is chronic pancreatitis the most common cause of exocrine pancreatic insufficiency?

Chronic pancreatitis leads to prolonged inflammation of the pancreas, damaging the exocrine tissue and impairing the production of digestive enzymes, which causes EPI.

Can exocrine pancreatic insufficiency be diagnosed with a blood test?

There is a blood test called serum trypsinogen, but it is less sensitive and not as reliable as the fecal elastase test. Therefore, fecal elastase remains the preferred diagnostic test for EPI.

What is steatorrhea and why is it associated with exocrine pancreatic insufficiency?

Steatorrhea refers to the presence of excessive fat in the stool, which occurs when the body is unable to properly digest and absorb fat due to insufficient pancreatic enzymes. This leads to oily, foul-smelling stools.

What is the 72-hour fecal fat test and how is it used to diagnose exocrine pancreatic insufficiency?

The 72-hour fecal fat test involves collecting stools over three days while the patient consumes a high-fat diet. The collected stool is then analyzed for fat content, which helps assess whether the body is absorbing fat properly. This test is often used as a stress test for the digestive system.

What are some other tests used to diagnose exocrine pancreatic insufficiency besides fecal elastase?

Other diagnostic tests include the Sudan stain, which detects fat globules in stool, and the 72-hour fecal fat test. These tests also help assess fat absorption, but the fecal elastase test is preferred for its sensitivity and reliability.