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The fecal elastase test measures the concentration of the elastase-3B enzyme found in fecal matter with an enzyme-linked immunosorbent assay . Results of this test can give a good indication of exocrine pancreatic status, and the test is less invasive and expensive than the current "gold standard" , secretin-cholecystokinin test. [ 9 ]
Pancreatic elastase is a compact globular protein with a hydrophobic core. This enzyme is formed by three subunits. Each subunit binds one calcium ion ().There are three important metal-binding sites in amino acids 77, 82, 87. [4]
The fecal elastase test is a less cumbersome test that has replaced the 72-hour fecal fat test; in the fecal elastase test, pancreatic enzyme replacement therapy (enzyme supplementation, the treatment for EPI) does not have to be stopped for or during fecal elastase testing. [25]
In chronic pancreatitis, the fecal pancreatic elastase-1 (FPE-1) test is a marker of exocrine pancreatic function. Additional tests that may be useful in evaluating chronic pancreatitis include hemoglobin A1C , immunoglobulin G4 , rheumatoid factor , and anti-nuclear antibody .
A fecal pH test may be used to determine lactose intolerance or the presence of an infection. [13] Steatorrhea can be diagnosed using a fecal fat test, which checks for the malabsorption of fat. [14] Faecal elastase levels are becoming the mainstay of pancreatitis diagnosis.
Exocrine pancreatic insufficiency can be confirmed by also checking a fecal elastase level, with low levels specifying exocrine pancreatic insufficiency. [3] A quantitative fecal fat test can also be done to quantify the fat levels in the stool and confirm the presence of exocrine pancreatic insufficiency. [3]