A recent meta-analysis has shown that pancreatic elastase test has a combined sensitivity of 0.77 in detecting exocrine pancreatic insufficiency (Vanga, Rohini R. et al. Clinical Gastroenterology and Hepatology, 2018). What's the impact of this reported sensitivity in current clinical practice? Would a test with higher sensitivity make a positive and significant impact on time-to-diagnosis?
Dear Roger Mallol
Kindly follow links below for some suggestions
Article Practical guide to exocrine pancreatic insufficiency – Break...
https://emedicine.medscape.com/article/2121028-workup
Article Diagnostic Performance of Measurement of Fecal Elastase-1 in...
Not at all. Pancreatic elastase by itself may be sensitive to diagnose PEI only when it is severe, otherwise it has to be combined with other tests.
Thank you very much for your answer. Do you know what's the impact of misdiagnosing mild cases? Is this low sensitivity in mild cases due to the technical approach, i.e. would an activity assay give more information than an immunoassay?
Hi Roger. Thank you for your question. As a general rule in medicine, we do not make a diagnosis of a disease based on one test. The diagnosis is usually based on the patient's presenting problems, clinical examination findings, and investigation results that can locate the site/place of the disease (X-rays, CT scans, MRI scans, endoscopies, echocardiography), any physiological changes (such as liver function tests, renal function tests, thyroid function tests, echocardiography etc), and the nature of pathological changes (biopsies for histopathological examinations, biochemical markers etc), and assessment of the impact of the disease on other body organs/systems. While a test could have a higher sensitivity, as you mentioned, we would like to know the specificity of the test as well. A higher sensitivity, as it is the case with ESR, may not be that helpful as the reading cannot help as such in assessing a differential diagnosis. In the case of ESR, again a very high ESR value, above 100, could indicate malignancy or multiple myeloma. While a mildely raised ESR could be due to a range of cause such as infection, inflammation, hormonal changes etc.s I hope this helps. Best regards. Prof S Azer
Mild cases are better picked up by investigations like endoscopic ultrasound, MRI/CT Scan. The level of elastase by different assays adds little to the diagnosis.
as guatam wrote, you can only detect EPI via pancreatic stool testing when > 90 % of its function is lost. the most sensitive, non invasive test would be to check for fat reabsorbtion coefficient.
Maybe the following papers will help you:
1. Colin Wallis,Theresa Leung,David Cubitt,Anthony Reynolds.Stool elastase as a diagnostic test for pancreatic function in children with cystic fibrosis. Volume 350, No. 9083, p1001, 4 October 1997
2. Hammer H.F..Pancreatic Exocrine Insufficiency: Diagnostic Evaluation and Replacement Therapy with Pancreatic Enzymes. 2010, Vol.28, No. 2
3. Lindkvist B. Diagnosis and treatment of pancreatic exocrine insufficiency. World Journal of Gastroenterology : WJG. 2013;19(42):7258-7266. doi:10.3748/wjg.v19.i42.7258.
4. Struyvenberg MR, Martin CR, Freedman SD. Practical guide to exocrine pancreatic insufficiency – Breaking the myths. BMC Medicine. 2017;15:29. doi:10.1186/s12916-017-0783-y.
Dear Roger Mallol
Kindly follow links below for some suggestions
Article Practical guide to exocrine pancreatic insufficiency – Break...
https://emedicine.medscape.com/article/2121028-workup
Article Diagnostic Performance of Measurement of Fecal Elastase-1 in...
This is useful in moderate and severe cases of pancreatic insufficiency but not in mild cases
Dear Colleague, As far as children are concerned I do not have personal
experience with serum elastase, but I will ask other experts und send you ,hopefully, an answer to yours question yours sincerely Hadorn
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