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

Abstract

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.

• Authors: D A Elphick, K Kapur
• Journal: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] (Pancreatology) Vol. 5 Issue 2-3 Pg. 196-200 ( 2005) ISSN: 1424-3903 [Print] Switzerland
• PMID: 15849489 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

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

Topics

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