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Fecal Elastase Test (FET)
Fecal Elastase Test (FET): Overview and Clinical Significance
The fecal elastase test (FET) measures the concentration of pancreatic elastase-1 in stool to assess exocrine pancreatic function. This enzyme, produced by pancreatic acinar cells, is critical for digesting proteins and remains stable during intestinal transit, making it a reliable marker for pancreatic insufficiency.
Purpose of the Test
FET is primarily used to diagnose exocrine pancreatic insufficiency (EPI), a condition where the pancreas fails to produce sufficient digestive enzymes. EPI is associated with:
- Chronic pancreatitis
- Cystic fibrosis
- Pancreatic cancer
- Post-pancreatic surgery
- Symptoms like chronic diarrhea, steatorrhea (fatty stools), weight loss, and malnutrition125.
Procedure and Specimen Requirements
- Specimen Collection: A fresh stool sample (5 g) is collected without preservatives.
- Handling:
- Preferred: Frozen storage/transport.
- Acceptable: Refrigerated or ambient if tested within 72 hours6.
- Method: Enzyme-linked immunosorbent assay (ELISA) detects elastase levels6.
Interpretation of Results
- Normal: >200 mcg/g – No pancreatic insufficiency.
- Moderate EPI: 100–200 mcg/g – Suggests mild-moderate enzyme deficiency.
- Severe EPI: <100 mcg/g – Confirms significant exocrine pancreatic dysfunction36.
Advantages Over Other Tests
- Non-Invasive: Unlike invasive endoscopic procedures.
- Convenience: Avoids the cumbersome 72-hour fecal fat test, which requires strict dietary fat intake567.
- Stability: Elastase resists degradation, ensuring accurate results even with delayed processing6.
Limitations
- False Normals: Normal results do not fully exclude EPI, especially in early-stage chronic pancreatitis6.
- Specimen Issues: Samples from diapers or contaminated with urine are rejected. Watery stools may yield unreliable results6.
- Extrapancreatic Causes: Does not differentiate EPI from other causes of malabsorption (e.g., celiac disease)8.
Clinical Utility
- Diagnosis: First-line test for suspected EPI in chronic pancreatitis or cystic fibrosis26.
- Monitoring: Tracks pancreatic function in diabetes, post-surgical patients, or those on enzyme replacement therapy6.
Comparison to Fecal Fat Testing
While the 72-hour fecal fat test directly measures fat malabsorption, FET is preferred due to its simplicity and patient tolerability. FET correlates well with severe steatorrhea but may miss mild cases68.
Conclusion
The fecal elastase test is a key tool for diagnosing and managing EPI, offering a non-invasive, reliable assessment of pancreatic function. While it has limitations, its ease of use and accuracy make it a first-choice test in clinical practice.
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At DrStemCellsThailand (DRSCT)‘s Anti-Aging and Regenerative Medicine Center of Thailand, we emphasize comprehensive evaluations and personalized treatment plans of Cellular Therapy and Stem Cells for managing various health conditions. If you have questions about Fecal Elastase Test (FET) or would like more information on our services, consult with our experts today!
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References
