Sharma, V.; Thorpe, E.; Samuell, C.; Pereira, S.P.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA78
Academic Journal
The urinary pancreolauryl (UPL) test is used widely for the non-invasive diagnosis of exocrine pancreatic insufficiency, but is time consuming and reported to be unreliable in mild to moderate exocrine insufficiency. A highly sensitive enzyme linked immunosorbent assay for faecal elastase-1 (FE1) using two specific monodonal antibodies is now commercially available. Aim: To compare UPL and FE1 test results in a group of patients with well characterised (CT, MRCP ± ERCP) chronic pancreatitis with and without overt exocrine pancreatic insufficiency. Methods: Paired UPL and FE1 data were obtained in 51 patients (36 M, 15 F; mean age 52 year, range 29-77 year). Standard cutoff values for the UPL test (< 20% fluorescein recovery from the orally administered ester abnormal, 20-30% equivocal) and FE1 test (< 200 µg/g faeces abnormal) were used. Results: There was concordance between the two tests in 31 (61%) patients (both UPL and FE1 normal in 12, abnormal in 19). Two of the 12 patients with normal UPL/FE1, and all 19 in whom both tests were abnormal, had moderate or severe morphological changes in the pancreas on CT/ERCP (Cambridge classification). Six patients had equivocal UPL results, none of whom had overt exocrine insufficiency and only one of whom had a Iow FE1. Two patients (4%) had normal UP/but Iow FE1 (both had moderate/severe morphological changes), while 12 (24%) had Iow UPL but normal FE1 (2 moderate/severe). Conclusions: The FE1 test is simpler to perform than the UPL test, and correlates well with abnormalities of the pancreas seen on structural imaging.


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