Explanation

Pancreatic elastase (stool): what is measured?

The pancreas makes digestive enzymes that cut proteins, fats and carbohydrates into small pieces, so that the intestine can absorb them. Elastase is one of those enzymes. It is not broken down on its way through the intestine, so the amount in the stool is a measure of what the pancreas makes. The test measures the number of micrograms of elastase per gram of stool.

What can it detect?

Reduced digestive function of the pancreas (exocrine pancreatic insufficiency)
A sign of chronic inflammation of the pancreas (chronic pancreatitis)
Rarely: cystic fibrosis or a tumor of the pancreas as the cause of a very low value

Result

What does the result mean?

Pancreatic elastase (stool) too high

A normal or high value means that the pancreas releases enough digestive enzymes. A high value on its own has no known meaning and does not call for further tests. Symptoms such as diarrhea, a bloated feeling or abdominal pain then have another cause, for example irritable bowel syndrome, celiac disease or a food intolerance.

Pancreatic elastase (stool) too low

A low value points to the pancreas making too few digestive enzymes. The lower the value, the more the function of the pancreas is reduced. Symptoms that go with this are fatty, mushy or foul-smelling stools that are hard to flush away, a bloated feeling, flatulence, abdominal pain and unintended weight loss; over time, deficiencies of vitamins A, D, E and K can develop. Causes include chronic inflammation of the pancreas (in the Western world, about 70 in 100 cases are due to alcohol), surgery on the pancreas and cystic fibrosis. Rarely: a tumor of the pancreas. With watery stools the result can be falsely low due to dilution.

After an abnormal result

With a low value, the GP usually repeats the test on a formed stool sample and looks for an explanation, for example in the medical history or alcohol use. With a persistently low value, referral to a gastroenterologist or internist (specialist in internal medicine) follows for further tests, such as imaging of the pancreas and measuring vitamins.

Reliability

How reliable is the test?

According to the Dutch Society for Clinical Chemistry (NVKC), the test gives a good picture of the digestive function of the pancreas and is more useful for this than older enzyme tests, because elastase is not broken down in the intestine. The test says nothing about the cause of reduced function. The result is most meaningful with symptoms that fit poor fat digestion; in people without symptoms, a slightly low value is harder to interpret. The pancreas has a lot of reserve: symptoms usually only appear when a large part of the tissue is damaged.

What can affect the result?

With watery stools the result can be falsely low; a formed stool sample gives a more reliable picture.
Cut-off values depend on the test used and the laboratory; a value just below the cut-off calls for a repeat test.
The test says nothing about the cause: a low value always calls for further tests.
Different values apply to young infants, because elastase is still rising in the first month of life.

Who it is for

Who is the test useful for?

Useful for

Useful with symptoms that may fit poor fat digestion: long-lasting fatty or mushy stools, unintended weight loss, or symptoms with a known condition of the pancreas. Also for people who drink or have drunk a lot of alcohol and have such symptoms. In people without bowel symptoms or weight loss, the test is not useful.

How common is it?

Chronic inflammation of the pancreas is not common: European studies find 1.6 to 23 new cases per 100,000 people per year. In about 30 in 100 of them, the digestive function of the pancreas is lost. No Dutch figures are known for a low pancreatic elastase as an isolated finding.

The Dutch medical specialists' guideline (FMS) on somatic complications of risky alcohol use (module on chronic pancreatitis)

Drawbacks and risks

A slightly low value, for example due to loose stools, can lead to unnecessary worry and further tests.
A normal value does not rule out symptoms from an early disorder of the pancreas, because the test only becomes abnormal after a considerable loss of function.

Get tested

Pancreatic elastase (stool): test panels

Pancreatic elastase (stool) is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.

Stool
4D Basic Package
Comprehensive basic analysis of intestinal health, including activity measurements and biomarkers.
€ 625,00
Stool
4D Specialist package
Comprehensive gut health analysis for patients with complex health problems.
€ 975,00
Stool
4D Extended package
In-depth investigation of gut health, biodiversity, and biomarkers for persistent complaints.
€ 750,00
Stool
Gut therapy screening
Comprehensive screening of intestinal function and microbiome. Includes 15+ test parameters.
€ 900,00
Stool
Maldigestion/malabsorption
Examines pancreatic elastase and bile acids for pancreatic function and nutrient absorption.
€ 135,00
Stool
Pancreas elastase
This test measures the extent to which the pancreas produces digestive enzymes. Relevant when exocrine pancreatic insufficiency is suspected.
€ 135,00

Evidence

Sources

This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.

More about risks and results

More explanations

Other tests: Gut

All tests

Pancreatic elastase (stool)

Pancreatic elastase (stool): what is measured?

What can it detect?

What does the result mean?

Pancreatic elastase (stool) too high

Pancreatic elastase (stool) too low

After an abnormal result

How reliable is the test?

What can affect the result?

Who is the test useful for?

Useful for

How common is it?

Drawbacks and risks

Pancreatic elastase (stool): test panels

4D Basic Package

4D Specialist package

4D Extended package

Gut therapy screening

Maldigestion/malabsorption

Pancreas elastase

Sources

Other tests: Gut

Pancreatic elastase (stool)

Pancreatic elastase (stool): what is measured?

What can it detect?

What does the result mean?

Pancreatic elastase (stool) too high

Pancreatic elastase (stool) too low

After an abnormal result

How reliable is the test?

What can affect the result?

Who is the test useful for?

Useful for

How common is it?

Drawbacks and risks

Pancreatic elastase (stool): test panels

4D Basic Package

4D Specialist package

4D Extended package

Gut therapy screening

Maldigestion/malabsorption

Pancreas elastase

Sources

Other tests: Gut