Test Catalog

Test ID: ELASF    
Pancreatic Elastase, Feces

Useful For Suggests clinical disorders or settings where the test may be helpful

Diagnosis of exocrine pancreatic insufficiency in case of unexplained diarrhea, constipation, steatorrhea, flatulence, weight loss, upper abdominal pain, and food intolerances


Monitoring of exocrine pancreatic function in cystic fibrosis, diabetes mellitus, or chronic pancreatitis

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Pancreatic elastase (PE) is a proteolytic enzyme produced in the pancreatic acinar cells. It is released as a zymogen, which is then converted to an active enzyme in the duodenum by trypsin. PE has an important role in digestion, and proteolytically degrades proteins preferentially at alanine residues.


Exocrine pancreatic insufficiency (EPI) is described as a reduction in pancreatic enzyme activity below the normal digestive threshold level. Clinical symptoms of EPI include steatorrhea, bloating, abdominal discomfort, and weight loss. EPI is most commonly caused by chronic pancreatitis but can also be associated with pancreatic cancer, pancreatic surgery, necrotizing acute pancreatitis, cystic fibrosis, inflammatory bowel disease (both Crohn’s disease and ulcerative colitis), diabetes (types I and II), gastric surgery, short bowel syndrome, and Zollinger-Ellison syndrome. If left untreated, patients with EPI can experience weight loss and significant nutrient deficiencies. Treatment for EPI centers on administration of pancreatic enzyme replacement therapy.


Stool testing is a critical component for the diagnosis of EPI. The 72-hour fecal fat test is useful for evaluating for the presence of steatorrhea. However, this testing is cumbersome for the patient and not easily tolerated due to the requirement of consuming 100 g fat/day. An alternate to the 72-hour fecal fat test is the measurement of PE in stool. The amount of PE in stool is representative of pancreatic enzyme production; patients with EPI may have reduced concentrations of PE in feces.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

<100 mcg/g (Severe Pancreatic Insufficiency)

100-200 mcg/g (Moderate Pancreatic Insufficiency)

>200 mcg/g (Normal)

Reference values apply to all ages.

Interpretation Provides information to assist in interpretation of the test results

Pancreatic elastase concentrations above 200 mcg/g are normal and are not indicative of exocrine pancreatic insufficiency.

Pancreatic elastase concentrations from 100-200 mcg/g are suggestive for moderate exocrine pancreatic insufficiency.

Pancreatic elastase concentrations below 100 mcg/g are consistent with exocrine pancreatic insufficiency.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Normal concentrations do not exclude the possibility of EPI.


Consistency of raw fecal sample may affect analytical performance.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Leeds JS, Oppong K, Sanders DS: The role of fecal elastase-1 in detecting exocrine pancreatic disease. Nat Rev Gastroenterol Hepatol. 2011;8:405-415

2. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG: Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019;12:129-139

3. Chowdhury SD, Kurien RT, Ramachandran A, et al: Pancreatic exocrine insufficiency: Comparing fecal elastase 1 with 72-h stool for fecal fat estimation. Indian J Gastroenterol. 2016;35:441-444