Use of fecal elastase-1 to classify pancreatic status in patients with cystic fibrosis.

Abstract

OBJECTIVE:

To test the hypothesis that some patients with cystic fibrosis (CF) are misclassified as pancreatic insufficient, using fecal elastase-1 (FE-1) to define pancreatic status.

STUDY DESIGN:

Subjects with CF at 33 CF centers filled out questionnaires and submitted a stool specimen that was analyzed for FE-1. Subjects taking pancreatic enzyme supplements (PES) were asked to discontinue them and perform a 3-day fecal fat balance study if their FE-1 was >200 microg/g stool and they had never had pancreatitis.

RESULTS:

The median value for FE-1 in 1215 subjects was 0 microg/g stool (range, 0-867). There was a significant difference between patients who had been prescribed PES (n=1131) and those who had FE-1 <200 microg/g stool (n=1074; P<.0001). Sixty-seven subjects met criteria for discontinuation of PES. The mean coefficient of fat absorption for these subjects was 96.1%.

CONCLUSIONS:

FE-1 is an accurate, easily obtained screening test to classify pancreatic status in patients with CF. This information is important for prognostication, treatment, and to avoid misclassification in clinical research. Measurement of FE-1 should become a standard of care for patients with CF.

• Authors: Drucy Borowitz, Susan S Baker, Linda Duffy, Robert D Baker, Laura Fitzpatrick, Joyce Gyamfi, Kerry Jarembek
• Journal: The Journal of pediatrics (J Pediatr) Vol. 145 Issue 3 Pg. 322-6 (Sep 2004) ISSN: 0022-3476 [Print] United States
• PMID: 15343184 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• CFTR protein, human
• Cystic Fibrosis Transmembrane Conductance Regulator
• Pancreatic Elastase

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Cystic Fibrosis (complications)
• Cystic Fibrosis Transmembrane Conductance Regulator (genetics)
• Exocrine Pancreatic Insufficiency (classification, enzymology, etiology)
• Feces (enzymology)
• Female
• Humans
• Infant
• Male
• Middle Aged
• Mutation
• Pancreatic Elastase (isolation & purification, metabolism)
• Registries