Comparing the urinary pancreolauryl ratio and faecal elastase-1 as indicators of pancreatic insufficiency in clinical practice

Pancreatology. 2005;5(2-3):196-200. doi: 10.1159/000085271. Epub 2005 Apr 21.


Background: The urine pancreolauryl ratio (uPLR) and, more recently, the faecal pancreatic elastase-1, are widely used for the noninvasive diagnosis of exocrine pancreatic insufficiency. Both tests have previously been validated against 'gold standard' tests of pancreatic function, but their use in a clinical setting has never been directly compared.

Methods: We performed a comparative study of the pancreolauryl ratio (PLR) and the faecal elastase-1 (FE-1) test in patients with a clinical suspicion for pancreatic insufficiency. The results were compared with the clinical response to pancreatic enzyme supplementation using pre-defined criteria.

Results: Forty-five patients were enrolled in the study and 33 were given a trial of pancreatic enzyme supplementation. Twenty-four out of these 33 showed a positive clinical response to enzyme supplements. Of the 24 responders, 19 had positive FE-1 (<200 microg/g faeces), but only 12 had a positive uPLR (<20). There was a significant correlation between the FE-1 result and clinical response to enzyme supplements (p = 0.01), but not between the PLR and clinical response (p = 0.15).

Conclusions: FE-1 is a simpler test for the patient to perform and more accurately predicts the response to pancreatic enzyme supplementation in patients with chronic, unexplained diarrhoea with a clinical suspicion of pancreatic insufficiency than the PLR. This makes the FE-1 of greater use in clinical practice than the PLR.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Biomarkers / urine
  • Diarrhea / diagnosis
  • Diarrhea / metabolism
  • Enzymes / administration & dosage
  • Exocrine Pancreatic Insufficiency / diagnosis*
  • Exocrine Pancreatic Insufficiency / drug therapy
  • Exocrine Pancreatic Insufficiency / metabolism*
  • Feces
  • Fluoresceins* / pharmacokinetics
  • Humans
  • Pancreatic Elastase / metabolism*
  • Pancreatic Function Tests
  • Steatorrhea / diagnosis
  • Steatorrhea / metabolism


  • Biomarkers
  • Enzymes
  • Fluoresceins
  • fluorescein dilaurate
  • Pancreatic Elastase