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Pancreatobiliary
Original research
What is the significance of a faecal elastase-1 level between 200 and 500μg/g?
  1. Alok Mathew1,
  2. Darren Fernandes2,3,
  3. H Jervoise N Andreyev2,4
  1. 1 Royal Derby Hospital, Derby, UK
  2. 2 Department of Gastroenterology, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
  3. 3 School of Health and Social Care, Community and Health Research Unit, University of Lincoln, Lincoln, UK
  4. 4 The Biomedical Research Centre, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Darren Fernandes, Gastroenterology, United Lincolnshire Hospitals NHS Trust, Lincoln, UK; dcrfernandes{at}gmail.com

Abstract

Background Pancreatic exocrine insufficiency is a cause of malabsorption. It is generally diagnosed if faecal elastase-1 (FE-1) levels are below 200 µg/g. Pancreatic function is assumed to be normal when faecal elastase levels are >500 µg/g. The significance of faecal elastase levels above 200 µg/g but less than 500 µg/g is unclear.

Methods This retrospective study reports the response to treatment in patients who had an FE-1 level between 200 and 500 µg/g.

Results Of these 82 patients, 28 were offered pancreatic enzyme replacement therapy (PERT). A clinical response, defined as an improvement in their initial symptoms after commencing PERT, was seen in 20 patients (71%), 7 with potentially predisposing conditions and 13 with functional diarrhoea. PERT particularly abolished or improved diarrhoea, steatorrhoea and flatulence.

Conclusion Clinicians should, therefore, be aware that a trial of PERT given to patients with FE-1 levels between 200 and 500 µg/g may lead to improvement in gastrointestinal symptoms.

  • malabsorption
  • diarrhoea
  • pancreatic elastase-1
  • pancreatic enzymes

Data availability statement

All data relevant to the study are included in the article.

https://doi.org/10.1136/flgastro-2022-102271

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    Data availability statement

    All data relevant to the study are included in the article.

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    Footnotes

    • Contributors DF and HJNA came up with the concept for the study. AM and DF performed data collection and analysis. DF, AM and HJNA were all involved in writing and reviewing the final manuscript. DF is the guarantor of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.