To help detect and evaluate pancreatic insufficiency
Stool Elastase
When you have signs and symptoms such as stomach cramps, weight loss, malnutrition, malabsorption, delayed growth (in children) and fatty, foul-smelling stools and pancreatic insufficiency is suspected
A fresh formed stool sample that is not contaminated with urine
If you are taking pancreatic enzymes, you may be asked to discontinue them for 5 days prior to stool collection.
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How is it used?
The elastase test is used along with other tests, such as fecal fat and/or fecal chymotrypsin, to evaluate both children and adults for pancreatic insufficiency.
Pancreatic insufficiency is the inability of the pancreas to produce and/or transport enough digestive enzymes to break down food in the intestine and aid in the absorption of nutrients. It typically occurs as a result of ongoing and worsening pancreatic damage.
The elastase test is most effective at detecting severe insufficiency and not as effective for mild or moderate forms.
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When is it ordered?
An elastase test may be ordered when a person has signs and symptoms of pancreatic insufficiency, such as:
- Abdominal cramps and bloating
- Foul-smelling, bulky, greasy stools
- In children, an inability to gain weight, delayed growth
- Malabsorption
- Malnutrition
- Vitamin deficiencies
- Weight loss
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What does the test result mean?
A normal amount of elastase will be present in the stool of healthy individuals.
A decreased amount of stool elastase may mean that the person tested has pancreatic insufficiency. It is not diagnostic, but it does indicate that further testing may be indicated.
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Is there anything else I should know?
A stool that is watery, such as with diarrhea, is not a good sample as the water in the stool will dilute the elastase and decrease the amount measured.
If there are not enough pancreatic enzymes (and bile from the liver) available, then fat and other foods cannot be properly digested. If a condition prevents the intestines from absorbing nutrients, then they are "lost" by elimination in the stool. In both cases – improper digestion or absorption – the affected person can experience symptoms associated with malabsorption and, in severe cases, symptoms of malnutrition and vitamin deficiency.
People with pancreatic dysfunction often need to be monitored closely by their healthcare practitioner. They may find symptom relief and nutritional improvement from prescribed enzymes taken by mouth (oral) and vitamin supplements.
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How long will it take for results?
This depends on the laboratory performing the testing. Not all laboratories offer this test and your sample may need to be sent to a reference laboratory for testing. It may take several days for results to be available.
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What other laboratory tests might be done if I or my child has a normal elastase test?
If your signs and symptoms continue and a strong suspicion of pancreatic insufficiency remains, your healthcare practitioner may order stool tests for fecal fat and chymotrypsin or blood tests for amylase and lipase to look at other aspects of pancreas and digestive function. To learn more, read the article on Pancreatic Insufficiency.
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What causes pancreatic insufficiency?
Pancreatic insufficiency can be caused by regular bouts of acute pancreatitis or by chronic pancreatitis. It is less frequently but sometimes associated with pancreatic cancer. Other causes of insufficiency may include celiac disease, Crohn disease, autoimmune pancreatitis (immunoglobulin G4-related disease), Zollinger-Ellison syndrome, and some surgical procedures that can lead to a decrease in digestive system or pancreatic function.
In children, pancreatic insufficiency is most frequently associated with cystic fibrosis (CF) or Shwachman-Diamond syndrome (SDS). SDS is the second most common cause of inherited pancreatic insufficiency, after CF. All those with SDS have some degree of pancreatic insufficiency beginning in infancy.
Additionally, people who are carriers of one mutated copy of the CFTR gene, the gene typically responsible for cystic fibrosis, may have pancreatic insufficiency and experience the associated signs and symptoms. (See the article on CF Gene Mutations Testing to learn more about carriers.)



