Elastase-1 is an enzyme produced by the pancreas, an organ located behind the stomach. It plays a role in digestion, helping to break down food components.
It is part of a larger group of digestive substances made by the pancreas. Its presence indicates primary pancreatic function.
The Function of Pancreatic Elastase-1
Pancreatic elastase-1 is a protease, an enzyme designed to break down proteins. It is synthesized by acinar cells within the pancreas as an inactive form called a zymogen. This inactive form is released into the small intestine, the duodenum, where it is activated by trypsin.
Once activated, pancreatic elastase-1 digests various proteins, including elastin. This enzyme is highly stable as it travels through the digestive tract, remaining intact and resistant to degradation by other digestive enzymes.
The Fecal Elastase-1 Test
Given its stability, the concentration of pancreatic elastase-1 in a stool sample serves as a reliable indicator of the pancreas’s exocrine function. The fecal elastase-1 test is a non-invasive diagnostic method that measures the amount of this enzyme in stool.
Healthcare providers often request this test when individuals experience symptoms suggesting malabsorption, such as unexplained weight loss or fatty stools. To perform the test, a small stool sample, about one gram, is collected in a clean container. The sample is then analyzed in a laboratory, frequently using an enzyme-linked immunosorbent assay (ELISA) to quantify the elastase-1 concentration.
The test does not typically require specific dietary preparations or discontinuation of pancreatic enzyme supplements. A normal fecal elastase-1 level is above 200 micrograms per gram (mcg/g) of stool. Results below this threshold prompt further investigation into pancreatic function.
Understanding Low Elastase-1 Levels
Low levels of fecal elastase-1 indicate Exocrine Pancreatic Insufficiency (EPI). EPI occurs when the pancreas does not produce enough digestive enzymes for the proper breakdown and absorption of food nutrients. This insufficiency can lead to issues with digestion, particularly of fats.
Several underlying conditions can cause EPI. Chronic pancreatitis is a common cause in adults due to long-term inflammation and damage to the pancreas. Other causes include cystic fibrosis, a genetic disorder, and pancreatic cancer, which can obstruct the pancreatic ducts or destroy enzyme-producing cells. Celiac disease and Crohn’s disease are also associated with EPI.
The inability to properly digest food results in a range of symptoms. These often include fatty, oily, and foul-smelling stools (steatorrhea), unexplained weight loss, abdominal discomfort, bloating, and gas.
Treatment for Pancreatic Insufficiency
The primary treatment for Exocrine Pancreatic Insufficiency (EPI) is Pancreatic Enzyme Replacement Therapy (PERT). PERT involves taking prescription enzyme capsules that contain a mixture of digestive enzymes, including lipase, amylase, and proteases. These capsules are typically taken with meals and snacks to supplement the body’s own enzyme production.
This therapy helps the body properly digest food, absorb essential nutrients, and alleviate digestive symptoms. The dosage of PERT is individualized and often adjusted based on the severity of symptoms and dietary fat intake. Alongside PERT, healthcare providers often recommend dietary adjustments, such as a well-balanced diet and, if needed, taking fat-soluble vitamin supplements (A, D, E, K).