Introduction Pancreatic Exocrine Insufficiency (PEI) is underdiagnosed and faecal elastase (FE) testing underutilised. The impact of age, sex, ethnicity, pre-existing pancreatic endocrine dysfunction and indication for testing on faecal elastase results are poorly studied. Previous small studies have suggested an age related decline in FE levels. Our Institution serves an ethnically mixed population in South London and we have described previously un-know ethnicity differences in colonic polyp prevalence,1 intestinal metaplasia in Barrett’s oesophagus2 and vitamin D deficiency in inflammatory bowel disease.3
Methods A retrospective study on 530 patients who underwent FE testing from September 2011 to September 2015 was carried out. Patient demographics were retrieved from hospital records. Ethnicity was categorised as ‘Indian-subcontinent’ and “Non-Indian-subcontinent’ as previously described (1). Paediatric cases (age less than 1) and adults with incomplete data were excluded from analyses. These were performed using Analyse-it Version 2.30 for Microsoft Excel. 494 cases were analysed.
Results Mean age of study participants was 50.7 (sd 22.7), there were 251 females and 243 males. The mean FE in our population was 381µg/g (sd 166). 89/494 were diagnosed with PEI. There was no significant difference in FE result when analysed for age, sex, ethnicity and history of weight loss. No age related differences were found when analysed for mean age in those with normal v abnormal FE results (20.2 v 52.9, p = n.s.), age v FE level or age v FE level in those with PEI. Patients with pre-existing diabetes mellitus were significantly more likely to have PEI (DM v no DM: FE low in 28 v 16%, p = 0.03). Patients presenting with unexplained diarrhoea were significantly more likely to have PEI (diarrhoea v no diarrhoea: FE low in 20.5 v 10.6, p = 0.009).
Conclusion This is the first study investigating the effects ethnicity and indication for testing on FE result and the largest study looking at the effect of age. Contrary to earlier smaller studies we found no relationship to age. We identified that patients with diarrhoea rather than isolated weight loss have a higher detection rate for PEI. We confirmed previous observations that patients with diabetes have a higher rate of PEI. FE testing should routinely be carried out in patients with unexplained diarrhoea.
References 1 West NJ, Poullis A. Indian J Gastroenterol 2007.
2 Hewett R, Poullis A. Indian J Gastroenterol 2015.
3 Chatu S, Poullis A. Frontline Gastroenterol 2013.
Disclosure of Interest None Declared
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