Testing for pancreatic enzyme insufficiency

EPI is largely a clinical diagnosis, however laboratory testing can help confirm a diagnosis of EPI.3,5

The symptoms and severity of EPI can vary widely from patient to patient. If your patient presents with one or more symptoms of EPI, consider pancreatic enzyme insufficiency in your assessment.

There is no single convenient, or specific diagnostic test for EPI. Direct pancreatic function tests can be performed to detect mild or severe EPI, however indirect laboratory tests are more commonly used. Determination of fecal elastase can be used to try to distinguish between pancreatic causes and intestinal causes of malabsorption.

The American Gastroenterological Association (AGA) recommends a fecal elastase test as the most appropriate initial test to confirm a clinical diagnosis of EPI.4

 

Laboratory tests for EPI

Direct laboratory tests include:5

Secretin Pancreatic Function Test

Used to test how the pancreas responds to secretin, a hormone that triggers the release of digestive enzymes. For the test, the patient receives secretin through an intravenous (IV) line. The provider uses endoscopic ultrasound to collect fluid and test it for enzymes.

 

Indirect laboratory tests include:5,14

Fecal Elastase Test (FE-1)

The fecal elastase test measures elastase, an enzyme found in fluids produced by the pancreas. This test involves a single stool sample collection. The patient's stool sample is analyzed for the presence of elastase.

72-hour
Fecal Fat Test

For quantitative measurement of fat absorption, a 72-hour fecal fat collection can be performed. This requires the patient to eat a high‐fat diet for 5 days or longer and collect all stools for the last 72 hours of the regimen.

13C-MTG Breath Test

Often only available at limited centers, this mixed triglyceride breath test can be used to measure fat absorption.