Now that fecal elastase is available in the United States, should clinicians start using it?

Fecal elastase-1 estimation is an alternative fecal enzyme test for the detection of exocrine pancreatic insufficiency, which, in contrast to chymotrypsin estimation, uses monoclonal antibodies against human pancreatic elastase and is thus unaffected by simultaneous pancreatic enzyme replacement therapy. Similar to other indirect pancreatic function tests, it has a high sensitivity rate for detecting severe functional impairment of the gland. However, the two major problems for the clinician--namely diagnosing mild to moderate exocrine pancreatic insufficiency or chronic pancreatitis and differentiating pancreatic from nonpancreatic steatorrhea or diarrhea--cannot be solved by pancreatic elastase-1 determination. The test cannot be used in non-formed stool (ie, diarrhea) unless the stool is lyophilized. All in all, this new test does not seem to be the gold standard for pancreatic function that we have been waiting for.