Fecal elastase is a digestive enzyme created by the pancreas. This enzyme has a specific role in breaking down the fats, proteins, and carbohydrates from food. After the pancreas releases elastase into the small intestine, it travels through the digestive tract largely intact. This allows its concentration to be measured in a stool sample as an indicator of pancreatic function.
Purpose of the Fecal Elastase Test
The primary purpose of a fecal elastase test is to assess the exocrine function of the pancreas, which is its ability to produce and secrete digestive enzymes. Healthcare providers use this test to help diagnose a condition known as Exocrine Pancreatic Insufficiency (EPI). EPI occurs when the pancreas does not produce or release enough enzymes to properly digest food, leading to malabsorption of nutrients. This condition means the body cannot effectively break down food components for energy and cellular repair.
A physician may order this test when a person experiences persistent digestive problems that suggest malabsorption. Common symptoms include steatorrhea, which is characterized by oily, greasy, and unusually foul-smelling stools due to undigested fat. Other indicators are unexplained weight loss, chronic diarrhea, abdominal bloating, and pain.
Several underlying diseases can impair the pancreas and lead to EPI. Chronic pancreatitis, which is long-term inflammation of the pancreas, is a frequent cause. Other conditions linked to EPI include cystic fibrosis, diabetes, and Crohn’s disease, making the fecal elastase test a valuable diagnostic tool for people with these conditions who develop digestive issues.
The Testing Process
The fecal elastase test is a non-invasive procedure that requires the collection of a single stool sample. Patients can follow their normal diet and continue their regular medications before the test, but should always follow the specific instructions provided by a healthcare professional. The collection process is straightforward and can be done at home using a kit provided by a lab or doctor’s office.
For the results to be accurate, the sample must be solid and free from contamination with urine or toilet water, as this can interfere with the analysis. The collected specimen is then sent to a laboratory where the concentration of elastase is measured.
A very watery or diarrheal sample can dilute the concentration of the elastase enzyme, which may lead to a falsely low reading. A healthcare provider will take the sample’s consistency into account when interpreting the final test results.
Understanding the Results
The results of a fecal elastase test are reported as a concentration, measured in micrograms (mcg) of elastase per gram (g) of stool. A specific numerical value determines whether pancreatic enzyme output is normal or indicates some level of insufficiency.
A result showing a concentration greater than 200 mcg/g is considered normal and suggests that the pancreas is producing a sufficient amount of digestive enzymes. This finding indicates that EPI is unlikely, though a doctor may consider other tests if digestive symptoms persist.
When the elastase level is between 100 and 200 mcg/g, it is categorized as mild to moderate EPI. A result that falls below 100 mcg/g indicates severe Exocrine Pancreatic Insufficiency. A low result confirms that the symptoms are caused by the pancreas’s inability to produce or release enough digestive enzymes.
Managing Low Elastase Levels
The primary treatment for low elastase levels, which confirms EPI, is Pancreatic Enzyme Replacement Therapy (PERT). PERT involves taking prescription capsules that contain a mixture of digestive enzymes, including lipase, protease, and amylase, to supplement what the pancreas is no longer supplying. These capsules are taken with every meal and snack to help the body properly digest food and absorb necessary nutrients.
Dietary and lifestyle adjustments can also help manage symptoms and improve nutrient absorption. Patients may find it beneficial to consume smaller, more frequent meals throughout the day rather than three large ones to reduce the digestive workload. A dietitian can help create a meal plan that is both nutritious and manageable.
Because EPI interferes with fat digestion, it can also lead to deficiencies in fat-soluble vitamins, namely vitamins A, D, E, and K. A healthcare provider might recommend regular blood tests to monitor these vitamin levels and may prescribe supplements to prevent or correct any deficiencies that arise.