Introduction Faecal elastase 1 (FE) is a proteolytic enzyme secreted by the acinar cells of the pancreas. Its determination is a highly sensitive and specific tubeless pancreatic function test. The 2003 BSG guidelines were compiled to minimise investigations and maximise positive diagnoses for patients with diarrhoea lasting more than 4 weeks.1 We analysed the appropriate use of the faecal elastase test and its correlation with symptoms in a large district general hospital.
Methods This retrospective study included all patients who had a FE requested from April 2009 to March 2010. Data were analysed for indication, symptoms, outcome of the test, follow-up, other investigations and the use of creon.
Results Over a period of 1 year, 121 patients had a FE requested. Patient notes and laboratory information was only available for a total of 101 patients. Data were collected from these notes for further analysis. 19 patients (19%) had pancreatic insufficiency with low FE levels (ranging <15–144). 82 patients had normal FE levels (>500). In patients with a low FE levels, 12 patients had diarrhoea (63%), steatorrhoea (21%), abdominal pain (26%), weight loss (47%), alcohol history (15%), history of pancreatitis in (53%) and none of these patients had abdominal distention, flatulence or offensive stools. 58% in the low FE group had treatment with creon. A logistic regression analysis was performed on three symptoms; diarrhoea, steatorrhoea and previous history of pancreatitis. History of pancreatitis was statistically significant with an OR of 10.21, for faecal elastase insufficiency.
Conclusion In our study group we found that a previous history of pancreatitis was a strong predictor of a low faecal elastase. Though statistically not significant, patients with diarrhoea, steatorrhoea and weight loss, do benefit from FE testing.
Competing interests None declared.
Reference 1. Thomas PD, et al. Guidelines for the investigation of chronic diarrhoea. 2nd edn. Gut 2003;52(Suppl V):v1–5.
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