Pancreatic elastase-1 (PE-1)

A marker of exocrine pancreatic function. Is looked at with fat malabsorption, bloating and diarrhoea. How it is to be read is set out in your findings report.

What pancreatic elastase shows

After a meal, stimulated by the gut hormones cholecystokinin and secretin, the pancreas releases digestive juice into the duodenum. It contains lipase for splitting fats, amylase for starch, protein-splitting enzymes and bicarbonate, which neutralises the acidic chyme from the stomach. Elastase-1 is one of these protein-splitting enzymes. Unlike most digestive enzymes, it is hardly broken down on its way through the gut; how much of it arrives in stool therefore shows how much digestive juice the pancreas releases overall. The test only recognises human elastase – porcine enzyme preparations do not change the value.

Low pancreatic elastase – what happens in the body?

A low value shows that the pancreas releases less digestive juice. This affects fat digestion most clearly, because hardly any other enzyme can replace lipase: dietary fats are not split sufficiently, reach the large intestine undigested and make the stool bulky, greasy and foul-smelling. Gut bacteria ferment the undigested residues, which increases bloating and abdominal pain. Along with fat, the fat-soluble vitamins A, D, E and K are absorbed less well, and with marked deficiency body weight falls. Low values occur with chronic inflammation of the pancreas, cystic fibrosis, diabetes and after surgery on the stomach or pancreas. Very watery stool dilutes the sample and can make the value appear too low.

High pancreatic elastase – what does it mean?

A high value shows that the pancreas releases plenty of digestive juice and that the splitting of fats, proteins and starch is secured on this side. A high value usually has no significance of its own; if digestive complaints are still present, the causes usually lie elsewhere, for example with bile, the small intestinal lining or the gut flora.