Usefulness of faecal elastase-1 assay in monitoring pancreatic function in childhood coeliac disease.

Abstract

BACKGROUND:

In coeliac disease it has been demonstrated that the indirect pancreatic function tests detect a greater percentage of subjects with exocrine pancreatic insufficiency than the secretin-caerulein test.

AIMS:

To evaluate faecal pancreatic elastase-1 assay in monitoring patients with coeliac disease.

PATIENTS:

Thirty patients with coeliac disease (11 m; age range 1-7 years) completed a 2-month follow-up. As controls, we studied two sex-, age-matched patient groups: a) 15 patients with cystic fibrosis, b) 40 surgical patients without gastroenterological disease.

METHODS:

In all coeliac subjects, stools were collected over 24 hours at diagnosis and then 30 and 60 days after commencement of the gluten-free diet; on a sample of the faeces we assayed elastase-1 activity. In the control patients, faeces were collected over 24 hours for elastase-1 assay only once. The coeliac patients only underwent the secretin-caerulein test, at diagnosis.

RESULTS:

Ten out of 30 coeliac patients (33%) had subnormal faecal elastase-1 values at diagnosis, while all the surgical controls had values within the normal range; median values in coeliac patients were significantly lower than those of the surgical controls (median 287 mcg/g, 95% CI 271-430, versus 487 mcg/g, 95% CI 426-538, p < 0.007). Cystic fibrosis patient values (median 10 mcg/g, 95% CI 7-155) were significantly lower than both those of coeliac patients and those of the surgical controls (p < 0.0001). The secretin-caerulein test showed that 7/30 coeliac patients (23%) had a deficiency in one or more pancreatic enzymes; all these subjects had below normal faecal elastase-1 values. During the follow-up, we observed a progressive reduction in the number of coeliacs with pancreatic impairment; however, after 2 months of gluten-free diet, faecal elastase-1 deficiency persisted in 2/30 coeliacs.

CONCLUSIONS:

Faecal elastase-1 determination in coeliac patients reveals a similar frequency and duration of pancreatic impairment to those observed in studies performed using the faecal chymotrypsin assay; a reduction in faecal elastase-1 values can be linked to "non-typical pancreatic diseases".

• Authors: A Carroccio, G Iacono, S Ippolito, F Verghi, F Cavataio, M Soresi, L Giannitrapani, A Notarbartolo, G Montalto
• Journal: Italian journal of gastroenterology and hepatology (Ital J Gastroenterol Hepatol) Vol. 30 Issue 5 Pg. 500-4 (Oct 1998) ISSN: 1125-8055 [Print] Italy
• PMID: 9836106 (Publication Type: Clinical Trial, Comparative Study, Controlled Clinical Trial, Journal Article)

Chemical References

• Pancreatic Elastase

Topics

• Celiac Disease (diagnosis, enzymology)
• Child
• Child, Preschool
• Cystic Fibrosis (diagnosis, enzymology)
• Feces (chemistry)
• Female
• Humans
• Infant
• Male
• Monitoring, Physiologic (methods)
• Normal Distribution
• Pancreatic Elastase (analysis)
• Pancreatic Function Tests
• Prognosis
• Sensitivity and Specificity
• Statistics, Nonparametric