How useful is fecal pancreatic elastase 1 as a marker of exocrine pancreatic disease?

J Pediatr. 2002 Jul;141(1):84-90. doi: 10.1067/mpd.2002.124829.


Objectives: To evaluate the role of fecal elastase 1 (E1) as a marker of exocrine pancreatic insufficiency (PI).

Study design: Fecal E1 was measured in patient groups with (1) failure to thrive but no pancreatic or intestinal disease (disease control patients); (2) PI; (3) pancreatic sufficiency; and (4) steatorrhea caused by a variety of intestinal diseases.

Results: Fecal E1 in all disease control patients exceeded 200 microg/g stool. Only 1 (2%) of 50 patients with PI exceeded the minimum reference value of 100 microg/g stool. In contrast, 3 (11%) of 28 patients with pancreatic sufficiency (with Shwachman-Diamond syndrome) had fecal E1 concentrations <100 microg/g stool, as did 5 (20%) of 25 patients with steatorrhea from intestinal causes, all of whom had diluted feces caused by short gut.

Conclusions: Fecal E1 is a useful noninvasive screening test of PI in childhood. A negative test (>100 microg/g stool) had 99% predictive value for ruling out PI. However, a positive test in those with short gut or Shwachman-Diamond syndrome must be interpreted with caution.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cystic Fibrosis / complications
  • Exocrine Pancreatic Insufficiency / diagnosis*
  • Exocrine Pancreatic Insufficiency / etiology
  • Feces / chemistry
  • Humans
  • Infant
  • Malabsorption Syndromes / complications
  • Pancreatic Elastase / metabolism*
  • Pancreatic Function Tests / methods*
  • Sensitivity and Specificity


  • Biomarkers
  • Pancreatic Elastase