Fecal pancreatic elastase 1 in the work up of patients with chronic diarrhea

Background. Quantitative determination of pancreatic elastase-1 (E1) in sto ols has been proposed as a novel, noninvasive test of pancreatic function. The aim of the study was to verify its role in the differential diagnosis o f chronic diarrhea. Methods. E1 was measured in spot stool samples of 50 patients with pancreat ic disease (PD), 62 with inflammatory bowel disease (IBD), 45 with chronic diarrhea (CD), 34 with other gastroduodenal and liver disease (gastrointest inal; GI), and in Is normal controls, by a commercial kit (Schebo-Tech. Wet temburg, Germany). Results. In PD, patients with severe damage and diarrhea displayed E1 level s below 100 mug/g; normal values were found in mild-moderate disease. Abnor mal values were detected in 4 CD and in 14 IBD patients, either in the pres ence of severe protein malnutrition or in patients with previous ileo-anal pouch anastomosis and pouchitis. In nine cases, values reverted to normal a fter adequate treatment. Diagnostic accuracy of Ef in discriminating diarrh ea of pancreatic and nonpancreatic origin was: SS, 97%; SP, 84%; VP+, 66%; VP-,100%. Conclusion. 1) The finding of a normal E1 value rules out a malabsorption o f pancreatic origin. 2) in CD and IBD, decreased E1 might be owing to bacte rial elastase degradation (pouchitis) or transient defective pancreatic enz yme secretion.