Elastase-1 in stool

Determination of elastase-1 (EL-1) in stool
Determination of pancreatic elastase-I in stool Human pancreatic elastase 1 is produced by pancreatic acinar cells. The enzyme is part of the pancreatic juice that is produced in the duodenum. During intestinal passage, the protein sequence of the enzyme selected for immunochemical detection is not degraded. The determination of elastase is therefore more diagnostically beneficial than chromogenic methods for the determination of chymotrypsin in faeces, the determination of lipase in faeces is also irrelevant. Human pancreatic elastase 1 activity in stool samples reflects the degree of exocrine pancreatic function. Recent applications recommend the determination of pancreatic elastase-1 in duodenal juice in a stimulated functional test. The determination of elastase-1 in stool in clinical diagnosis is of clinical importance :


 * malabsorption syndrome ,
 * as a screening test for pancreatic disease,
 * long-term follow-up of patients with chronic pancreatitis.

Laboratory method
Determination of elastase-I in stool The laboratory method is based on immunoassay by ELISA with a monoclonal (or polyclonal) antibody to human pancreatic elastase. The stool sample is homogenized in the extraction buffer solution and, after a dilution of 1: 500, further processed by a standard ELISA procedure on a microtiter plate with POD-streptavidin detection. The kit contains 5 calibration standards in the range of 0.3-10.0 ng / ml.

Reference values
The reference values ​​are 200–500 µg / g stool, the cut-off range is 100–200 µg / g, severe pancreatic insufficiency is determined at values ​​<100 µg / g stool. Immunochemical determination of elastase-1 is not affected by colonic passage, replacement therapy, or other factors that affect the enzymatic determination of chymotrypsin in the stool. The specificity of the method is 93%, the sensitivity reaches 100% for severe pancreatic insufficiency, 87% for medium and light forms. This test is commonly used in pediatrics to detect cystic fibrosis with a specificity and sensitivity of almost 100%. False reduction may be due to dilution (water content) during diarrhea.

related articles

 * Acute pancreatitis (laboratory diagnosis)
 * Chronic pancreatitis (laboratory diagnosis)
 * Breath tests
 * Indirect tests of pancreatic exocrine function

Source

 * with the permission of the author taken from KOCNA, Petr. GastroLab: MiniEncyclopedia of laboratory methods in gastroenterology  [online]. © 2002. Last revision 2011-01-08, [cit. 2011-03-04]. < http://www1.lf1.cuni.cz/~kocna/glab/glency1.htm >.

Reference

 * TRAN, TC, et al. Pancreatic fibrosis correlates with exocrine pancreatic insufficiency after pancreatoduodenectomy. Dig Surg. 2008, vol 25, no. 4, pp. 311-8, ISSN 0253-4886 (Print). 1421-9883 (Electronic). PMID: 18818498.


 * ERICKSON, JA, et al. Evaluation of a fecal pancreatic elastase-1 enzyme-linked immunosorbent assay: Assessment versus an established assay and implication in classifying pancreatic function. Clin Chim Acta. 2008, vol 397, no. 1-2, pp. 87-97, ISSN 0009-8981 (Print), 1873-3492 (Electronic). PMID: 18706899.


 * LIEB, JG, et al. Pancreatic function testing: here to stay for the 21st century. World J Gastroenterol. 2008, vol 14, no. 20, pp. 3149-58, ISSN 1007-9327. PMID: 18506918.


 * HAHN, JU, et al. Low fecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas. 2008, vol 36, no. 3, pp. 274-8, ISSN 0885-3177 (Print) 1536-4828 (Electronic). PMID: 18362841.


 * PEZZILLI, R, et al. Fecal calprotectin and elastase 1 determinations in patients with pancreatic diseases: a possible link between pancreatic insufficiency and intestinal inflammation. J Gastroenterol. 2007, vol 42, no. 9, pp. 754-60, ISSN 0944-1174 (Print), 1435-5922 (Electronic). PMID: 17876545.


 * GILLAMS, A., et al. Correlation of MRCP quantification (MRCPQ) with conventional non-invasive pancreatic exocrine function tests. Abdom Imaging. 2008, vol 33, no. 4, pp. 469-73, ISSN 0942-8925 (Print), 1432-0509 (Electronic). PMID: 17653788.


 * BOROWITZ, D, et al. Comparison of monoclonal and polyclonal ELISAs for fecal elastase in patients with cystic fibrosis and pancreatic insufficiency. J Pediatrician Gastroenterol Nutr. 2007, vol 44 (2): 219-23, no. 2, pp. 219-23, ISSN 0277-2116 (Print), 1536-4801 (Electronic). PMID: 17255835.


 * NARUSE, S, et al. Fecal pancreatic elastase: a reproducible marker for severe exocrine pancreatic insufficiency. J Gastroenterol. 2006, vol 41, no. 9, pp. 901-8, ISSN 0944-1174 (Print), 1435-5922 (Electronic). PMID: 17048055.


 * KRECHLER, T, et al. Faecal elastase I - its use in diagnosis of chronic pancreatitis. Cas Lek Cesk. 2006, vol 145, no. 6, pp. 480-3, ISSN 0008-7335. PMID: 16836002.


 * SENKAL, M, et al. Pancreatic elastase-1 in the stool for the determination of exocrine pancreas function of postoperative patients with early enteral nutrition - a pilot study. Dtsch Med Wochenschr. 2006, vol 131, no. 1-2, pp. 13-6, ISSN 0012-0472 (Print), 1439-4413 (Electronic). PMID: 16374736.


 * ELPHICK, DA, et al. Comparing the urinary pancreolauryl ratio and faecal elastase-1 as indicators of pancreatic insufficiency in clinical practice. Pancreatology. 2005, vol 5, no. 2-3, pp. 196-200, ISSN 1424-3903 (Print), 1424-3911 (Electronic). PMID: 15849489.


 * MOLINARI, I, et al. Fecal chymotrypsin and elastase-1 determination on one single stool collected at random: diagnostic value for exocrine pancreatic status. Clin Biochem. 2004, vol 37, no. 9, pp. 758-63, ISSN 0009-9120 (Print), 1873-2933 (Electronic). PMID: 15329313.


 * MIENDJE, Y, et al. Polyclonal versus monoclonal ELISA for the determination of fecal elastase 1: diagnostic value in cystic fibrosis and chronic pancreatic insufficiency. Clin Lab. 2004, vol 50, no. 7-8, pp. 419-24, ISSN 1433-6510. PMID: 15330510.


 * STEVENS, T, et al. Analysis of pancreatic elastase-1 concentrations in duodenal aspirates from healthy subjects and patients with chronic pancreatitis. Dig Dis Sci. 2004, vol 49, no. 9, pp. 1405-11, ISSN 0163-2116 (Print), 1573-2568 (Electronic). PMID: 15481311.


 * LANKISCH, PG. Now that fecal elastase is available in the United States, clinicians should start using it ?. Curr Gastroenterol Rep. 2004, vol 6, no. 2, pp. 126-31, ISSN 1522-8037 (Print), 1534-312X (Electronic). PMID: 15191690.


 * BRYDON, WG, et al. Limitations of faecal elastase-1 and chymotrypsin as tests of exocrine pancreatic disease in adults. Ann Clin Biochem. 2004, vol. 41, pp. 78-81, ISSN 0004-5632 (Print), 1758-1001 (Electronic). PMID: 14713391.


 * HARDT, PD, et al. The commercially available ELISA for pancreatic elastase 1 based on polyclonal antibodies does measure an as yet unknown antigen different from purified elastase 1. Binding studies and clinical use in patients with exocrine pancreatic insufficiency. From Gastroenterol. 2003, vol 41, no. 9, pp. 903-6, ISSN 0044-2771 (Print), 1439-7803 (Electronic). PMID: 13130326.


 * WALKOWIAK, J, et al. Comparison of faecal lipase test and faecal elastase-1 test in the assessment of exocrine pancreatic function in cystic fibrosis. With Development Age. 2003, vol 7, no. 2, pp. 149-55, ISSN 1428-345X. PMID: 12878785.


 * SONWALKAR, SA, et al. A prospective, comparative study of the para-aminobenzoic acid test and faecal elastase 1 in the assessment of exocrine pancreatic function. Aliment Pharmacol Ther. 2003, vol 17, no. 3, pp. 467-71, ISSN 0269-2813 (Print) 1365-2036 (Electronic). PMID: 12562462.


 * TAKEDA, M, et al. Fecal elastase-1 test: clinical evaluation of a new noninvasive pancreatic function test. Rinsho Byori. 2002, vol 50, no. 9, pp. 893-8, ISSN 0047-1860. PMID: 12386968.


 * WALKOWIAK, J, et al. Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis. Pediatrics. 2002, vol 110, no. 1, pp. E7-e7, ISSN 0031-4005 (Print), 1098-4275 (Electronic). PMID: 12093988.


 * BEHARRY, S, et al. How useful is fecal pancreatic elastase 1 as a marker of exocrine pancreatic disease ?. J Pediatr. 2002, vol 141, no. 1, pp. 84-90, ISSN 0022-3476 (Print), 1097-6833 (Electronic). PMID: 12091856.


 * DOMINICI, R, et al. Fecal elastase-1 as a test for pancreatic function: a review. Clin Chem Lab Med. 2002, vol 40, no. 4, pp. 325-32, ISSN 1434-6621. PMID: 12059069.


 * LÜTH, S, et al. Fecal elastase-1 determination: 'gold standard' of indirect pancreatic function tests ?. Scand J Gastroenterol. 2001, vol 36, no. 10, pp. 1092-9, ISSN 0036-5521 (Print), 1502-7708 (Electronic). PMID: 11589385.


 * ICKS, A, et al. Low fecal elastase-1 in type I diabetes mellitus. From Gastroenterol. 2001, vol 39, no. 10, pp. 823-30, ISSN 0044-2771 (Print), 1439-7803 (Electronic). PMID: 11605150.


 * CARROCCIO, A, et al. Diagnostic accuracy of fecal elastase 1 assay in patients with pancreatic maldigestion or intestinal malabsorption: a collaborative study of the Italian Society of Pediatric Gastroenterology and Hepatology. Dig Dis Sci. 2001, vol 46, no. 6, pp. 1335-42, ISSN 0163-2116 (Print), 1573-2568 (Electronic). PMID: 11414313.


 * NISSLER, K, et al. Pancreatic elastase 1 in feces of preterm and term infants. J Pediatrician Gastroenterol Nutr. 2001, vol. 33, no. 1, pp. 28-31, ISSN 0277-2116 (Print), 1536-4801 (Electronic). PMID: 11479404.


 * LEUS, J, et al. Detection and follow up of exocrine pancreatic insufficiency in cystic fibrosis: a review. Eur J Pediatr. 2000, vol 159, no. 8, pp. 563-8, ISSN 0340-6199 (Print), 1432-1076 (Electronic). PMID: 10968231.


 * PHILLIPS, IJ, et al. Faecal elastase 1: a marker of exocrine pancreatic insufficiency in cystic fibrosis. Ann Clin Biochem. 1999, vol 36, no. 6, pp. 739-42, ISSN 0004-5632 (Print), 1758-1001 (Electronic). PMID: 10586310.


 * GULLO, L, et al. Fecal elastase 1 determination in chronic pancreatitis. Dig Dis Sci. 1999, vol 44, no. 1, pp. 210-3, ISSN 0163-2116 (Print), 1573-2568 (Electronic). PMID: 9952246.