Comparison of two tubeless function tests in the assessment of mild-to-moderate exocrine pancreatic insufficiency

Background Faecal elastase 1 (FE1) and the pancreolauryl test (PLT) are wid ely used for the noninvasive diagnosis of exocrine pancreatic insufficiency (EPI). Whether one of these two tests is superior for the detection of mil d-to-moderate EPI is the subject of controversy. The aim of this study was to compare the diagnostic performance of the PLT and FE1 for the detection of EPI in patients with chronic pancreatitis. Methods Forty consecutive patients (27 males, 13 females, 23-72 years) with chronic pancreatitis based on imaging procedures (computed tomography, end oscopic retrograde pancreatography and endoscopic ultrasound) were admitted to the study. A secretin-caerulein test (SCT) was performed after an overn ight fast by giving secretin (1 U/kg/h) and caerulein (100 ng/kg/h) intrave nously over 90 min. Duodenal contents were aspirated at 15 min intervals an d analysed for pH, bicarbonate, amylase, lipase and elastase. EPI was grade d on the basis of the results of the SCT as absent, mild, moderate or sever e. A serum PLT was performed in accordance with a modified protocol previou sly described. A commercial ELISA was used for determination of FE1. The cu t-off values were greater than or equal to4.5 mg/l for PLT and greater than or equal to 200 mug/g for FE1. Results Thirty-three patients had EPI (20 mild/moderate and 13 severe) on t he basis of the results of the SCT. The sensitivity of the PLT for diagnosi ng EPI of all degrees of severity was 82% (27/33), compared with 50% for FE 1 (16/33). In patients with severe EPI, the PLT was abnormal in 100% (19/13 ) and FE1 was abnormal in 85% (11/13) of the cases. The sensitivity decreas es for both tests in the group of mild/moderate EPI (PLT 70% (14/20), FE1 3 5%(7/20)). in all seven patients with normal exocrine pancreatic function, both PLT and FE1 were also normal. Conclusions The PLT is more sensitive than FE1 for the diagnosis of mild-to -moderate EPI, and is therefore more appropriate for completing the staging of chronic pancreatitis. Eur J Gastroenterol Hepatol 12:1335-1338 (C) 2000 Lippincott Williams & Wilkins.