PTU-174 Low Faecal Elastase is not always Due to Pancreatic Insufficiency

Introduction Faecal elastase-1(FE-1) is a widely available, simple, cheap indirect pancreatic function test used in patients in whom pancreatic exocrine insufficiency (PEI) is suspected. Sensitivity is 73–100% for moderate to severe, but 0–63% for mild PEI 1 . Specificity of the test (80–100%) 1 is compromised in patients who have other causes of diarrhoea or type 1 diabetes 2,3 . The aim of this observational study was to examine the causes of low faecal elastase in our hospital. Methods A retrospective analysis of FE-1 tests performed between April 2010 and April 2012 was undertaken. The electronic medical notes of each patient with a low FE-1 ( Results Of the 288 samples received by the laboratory, 23 patients had FE-1 of less than 100 ug/l (severe). 18 patients had FE-1 of 100–199 ug/l (moderate) and 19 patients had FE-1 of 200–299 ug/l (mild). The results were grouped as shown in Table 1. In 5 of the moderate PEI group there was insufficient information to determine the diagnosis. Non-pancreatic causes included microscopic colitis, coeliac disease, bile salt malabsorption, irritable bowel syndrome and infection. In 2 patients the FE-1 was repeated; in 1 when treatment failed and FE-1 was still Conclusion This study shows that clinicians need to be aware that even in patients with FE-1 less than 100ug/l, the cause may be non-pancreatic in origin. FE-1 becomes a less reliable diagnostic tool in moderate to mild PEI parameters. FE-1 should be repeated if symptoms do not improve with pancreatic enzyme replacement. Symptoms may not be helpful in distinguishing pancreatic from non-pancreatic causes of low FE-1. Disclosure of Interest None Declared References Tod J, Fine D. Fecal elastase: a useful test for pancreatic insufficiency? Dig Dis Sci. 2010 Oct; 55(10):2709–11 Carroccio A, Verghi F, Santini B, et al. Diagnostic accuracy of faecal elastase 1 assay in patients with pancreatic maldigestion or intestinal malabsorption: a collaborative study of the Italian Society of Pediatric Gastroenterology and Hepatology. Dig Dis Sci 2001; 46:1335 Hahn JU, Kerner W, Maisonneuve P, et al. Low faecal elastase 1 levels do not indicate exocrine pancreatic insufficiency in type-1 diabetes mellitus. Pancreas 2008; 36:274