Faecal pancreatic elastase - 1 a non invasive measure of exocrine pancreatic function

Abstract

BACKGROUND: Faecal pancreatic elastase-1 is a laboratory based test used for the diagnosis or exclusion of exocrine pancreatic insufficiencies. Pancreatic elastase-1, is released into blood circulation during inflammation of the pancreas, but unlike most pancreatic enzymes it is stable during intestinal passage and not degraded. OBJECTIVES: The major objective of this work was to establish the assay of faecal pancreatic elastase-1 in spot stool samples as an exocrine pancreatic function test at Korle-Bu (a referral) hospital in Ghana, for the diagnosis of pancreatic diseases. METHOD: Twenty-five apparently healthy persons; mean age of 43.4 years and thirty-two patients with various pancreatic diseases, mean age 51.4 years were referred for the test based on clinical presentation, imaging studies and biopsy findings. The male to female ratio was 6.4:3.6 and 8.1:1.9 respectively. An ELISA technique which recognizes human pancreatic elastase-1 from spot stool samples was employed for the test and read photometrically at 405nm. RESULTS: Elastase-1 activity in spot stool samples from apparently healthy group ranged from 165 to 870mg/g with a mean of 379 (SE 41)mg/g, and a range of 20 to 285mg/g with a mean of 112.9 (SE 11.6)mg/g obtained for the pancreatic disease group. Disease severity was classified as mild to moderate with elastase-1 concentration between 100 and 200mg/g stool and the severe pancreatic insufficiency group with elastase-1 concentration of less than 100mg/g stool. The pancreatic elastase-1 was found to be stable in faeces for several weeks when stored frozen, hence the convenience for batch determinations. CONCLUSION: The test is non invasive and can assist with the diagnosis of inflammatory conditions of the pancreas where imaging results are equivocal.