Test Catalog

Test Id : MALP

Malabsorption Evaluation Panel, Feces

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

Evaluation of patients with suspected malabsorption, as suggested by chronic diarrhea, unexplained weight loss, or nutritional deficiencies

 

Differentiation between causes of malabsorption, specifically inflammatory conditions, pancreatic insufficiency, and osmotic diarrhea

 

Detection of protein-losing enteropathy that may be associated with an underlying malabsorption

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
A1AF Alpha-1-Antitrypsin, Random, F Yes Yes
CALPR Calprotectin, F Yes Yes
ELASF Pancreatic Elastase, F Yes Yes
UREDF Reducing Substance, F Yes Yes

Method Name
A short description of the method used to perform the test

A1AF: Nephelometry

CALPR, ELASF: Enzyme-Linked Immunosorbent Assay (ELISA)

UREDF: Benedict’s Copper Reduction Reaction

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Malabsorption Evaluation Panel, F

Aliases
Lists additional common names for a test, as an aid in searching

a-1-Antitrypsin, Feces

A1A

A1AT

Alpha 1 Antitrypsin

Alpha-1-Antitrypsin, Feces Only

Antitrypsin, Feces

Calprotectin

EL-1

Elastase

Elastase-1

FE-1

Fecal Elastase

Fecal malabsorption

Fecal sugar

Malabsorption

Malabsorption stool

Pancreatic Elastase-1

PE stool

PE-1

Stool sugar

UREDF

Specimen Type
Describes the specimen type validated for testing

Fecal

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation:

1. No barium enemas may be used for 48 hours prior to collection.

2. For 72 hours prior to collection:

-Do not use laxatives, including mineral oil and castor oil

-Do not eat synthetic fat substitutes such as Olestra.

-Do not take fat-blocking nutritional supplements

Supplies:

-Malabsorption Panel Kit (T920)

-Infectious Container, Wide Mouth (T429)

-2 Stool containers, Small (Random), 4 oz (T288)

Container/Tube: Stool container

Specimen Volume: 18 g split between 2 containers, each containing half of the specimen

Collection Instructions:

1. Collect a fresh, random fecal specimen, no preservative.

2. Split specimen between 2 small containers, each containing half of the specimen.

3. Label one small container with the A1AF and UREDF sample collection labels. Label the other small container with the CALPR, ELASF sample collection label.

4. Freeze immediately

Additional Information:

1. Specimen must be split prior to transport.

2. Testing cannot be added to a previously collected specimen.

3. Specimen cannot be collected from a diaper.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

5 g

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Urine and stool mixed
Specimens collected from diapers
Feces collected in any preservative or fixative
Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Fecal Frozen 7 days

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

Evaluation of patients with suspected malabsorption, as suggested by chronic diarrhea, unexplained weight loss, or nutritional deficiencies

 

Differentiation between causes of malabsorption, specifically inflammatory conditions, pancreatic insufficiency, and osmotic diarrhea

 

Detection of protein-losing enteropathy that may be associated with an underlying malabsorption

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

Malabsorption is defined as impaired gastrointestinal (GI) absorption of nutrients, including fats, proteins, carbohydrates, vitamins, and minerals. The classic presentation of malabsorption is chronic diarrhea; however, many patients may not display this symptomatology. Instead, they may present with mild GI symptoms and weight loss or with systemic manifestations associated with a specific nutrient deficiency.

 

Malabsorption can result from different pathologic mechanisms; identification of the specific cause is important for proper treatment. Evaluation for the cause of malabsorption requires a variety of blood and stool tests. Stool testing as a more direct marker of GI function is particularly useful for certain diseases. Fecal calprotectin concentrations are a reflection of the number of neutrophils in the GI tract, with an elevated result consistent with an inflammatory condition such as inflammatory bowel disease (IBD). Elastase is an enzyme produced by the pancreas and decreased concentrations in the stool are indicative of pancreatic insufficiency and malabsorption due to a deficiency in digestive enzymes.

 

The reducing substances test is useful in cases of chronic diarrhea; increased concentrations are consistent with osmotic diarrhea caused by disaccharidase deficiency or intestinal monosaccharide malabsorption. In comparison, measurement of alpha-1-antitrypsin in stool is not diagnostic for a specific malabsorption etiology but is useful for determining the extension of protein loss through the GI tract.

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.

ALPHA-1-ANTITRYPSIN, RANDOM:
< or =54 mg/dL

 

CALPROTECTIN:
<50.0 mcg/g (Normal)

50.0-120 mcg/g (Borderline)

>120 mcg/g (Abnormal)

Reference values apply to all ages.

 

PANCREATIC ELASTASE:
<100 mcg/g (Severe pancreatic insufficiency)

100-200 mcg/g (Moderate pancreatic insufficiency)

>200 mcg/g (Normal)

Reference values apply to all ages.

 

REDUCING SUBSTANCE:
Negative or trace

Interpretation
Provides information to assist in interpretation of the test results

Calprotectin concentrations above 120 mcg/g are suggestive of an active inflammatory process within the gastrointestinal system; additional diagnostic testing to determine the etiology of the inflammation is suggested.

 

Calprotectin concentrations between 50.0 and 120 mcg/g are borderline and may represent a mild inflammatory process; for patients with clinical symptoms suggestive of an inflammatory process, retesting in 4 to 6 weeks may be indicated.

 

Pancreatic elastase concentrations below 100 mcg/g are consistent with exocrine pancreatic insufficiency; pancreatic elastase concentrations from 100 to 200 mcg/g are suggestive for moderate exocrine pancreatic insufficiency.

 

Reducing substance concentrations above 0.50 g/dL are consistent with grade 2-4 osmotic diarrhea; reducing substance concentrations from 0.25 to 0.50 g/dL are consistent with grade 1 osmotic diarrhea.

 

Alpha-1-antitrypsin concentrations above 100 mg/dL are consistent with protein-losing enteropathy

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

Malabsorption can result from a variety of pathological conditions; for most individuals with malabsorption, appropriate evaluation includes blood and fecal testing in addition to clinical evaluation.

 

Due to the heterogeneous composition of fecal material, variability in results may be observed when patients are monitored over time.

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

1. Levitt DG, Levitt MD: Protein losing enteropathy: comprehensive review of the mechanistic association with clinical and subclinical disease states. Clin Exp Gastroenterol. 2017 Jul 17;10:147-168

2. Murray FR, Morell B, Biedermann L, Schreiner P: Protein-losing enteropathy as precursor of inflammatory bowel disease: A review of the literature. BMJ Case Rep. 2021 Jan 11;14(1):e238802

3. Gisbert JP, McNicholl AG: Questions and answers on the role of faecal calprotectin as a biological marker in inflammatory bowel disease. Digest Liver Dis. 2009 Jan;41(1):56-66

4. Sherwood RA, Walsham NE, Bjarnason I: Gastric, pancreatic, and intestinal function. In: Rifai N, Horwath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:1398-1420

5. Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG: Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol. 2019 Mar 21;12:129-139

6. 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 Nov;35(6):441-444

7. Siddiqui HA, Salwen MJ, Shaikh MF, Bowne WB: Laboratory diagnosis of gastrointestinal and pancreatic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. Elsevier; 2017:306-323

8. Branski D: Disorders of malabsorption. In: Kleigman RM, Stanton BF, St.Geme JW, eds. Nelson Textbook of Pediatrics. Elsevier; 2016:1831-1850

9. Krom FA, Frank CG: Clinitesting neonatal stools. Neonatal Network. 1989 Oct;8(2):37-40

10. Sacks DB: Carbohydrates: Qualitative methods for total reducing substances. In: Burtis CA, Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. 2nd ed. 1994;968-969

Method Description
Describes how the test is performed and provides a method-specific reference

Alpha-1-Antitrypsin:

Immunonephelometry quantitates the alpha-1-antitrypsin (AAT) contained in a fecal specimen. In the absence of a timed fecal collection, an AAT fecal concentration will be reported.(Instruction manual: Siemens Nephelometer II Operations. Siemens, Inc; Version 2.3, 2008; Addendum to the Instruction Manual 2.3. 08/2017)

 

Calprotectin:

The QUANTA Lite Calprotectin Extended Range assay is an enzyme-linked immunosorbent assay (ELISA). Briefly, polyclonal capture antibodies specific for human calprotectin are immobilized on a 96-well plate. Calibrators, controls, and diluted patient samples are added to the wells of the plate. If present, calprotectin will bind to the capture antibodies on the plate. After a wash step, a solution containing an enzyme-labelled antibody is added. After another wash step, a substrate solution is added, which will change color in the presence of the enzyme. The absorbance of the color produced is proportional to the amount of calprotectin in the patient sample. Lastly, the control and patient results are calculated based on a curve generated from the kit calibrators.(Packet insert: QUANTA Lite Calprotectin Extended Range ELISA kit. INOVA Diagnostics; 04/2019)

 

Pancreatic Elastase:

The Immundiagnostik Pancreatic Elastase assay is an ELISA. Calibrators, controls, and diluted patient samples are added to a 96-well plate pre-coated with monoclonal antibodies to pancreatic elastase. If present, pancreatic elastase will bind to the antibodies on the surface of the microtiter wells. After a wash step, a peroxidase-labeled conjugate (mouse anti-pancreatic elastase) is added. After another washing step, substrate tetramethylbenzidine (TMB) is added, which reacts with the peroxidase. An acidic stop solution is added, causing the color to change from blue to yellow. The intensity of the yellow color is directly proportional to the concentration of pancreatic elastase. A dose response curve of absorbance unit (optical density at 450 nm) vs. concentration is generated using the values obtained from the standards. Pancreatic elastase present in the patient samples is determined directly from this curve.(Package insert: IDK Pancreatic Elastase ELISA kit. Immundiagnostik AG; 2019)

 

Reducing Substances

Copper sulfate in the tablet reacts with reducing substances converting cupric sulfate to cuprous oxide.(Package insert: AimTab Reducing Substances Tablets. Germaine Laboratories, Inc; 12/2015)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

4 to 6 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

See individual test IDs

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

See Individual Test IDs

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82103

83993

82653

84376

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
MALP Malabsorption Evaluation Panel, F In Process
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
6215 Reducing Substance, F 11060-1
AAT_F Alpha-1-Antitrypsin, Random, F 9407-8
CALPR Calprotectin, F 38445-3
ELASF Pancreatic Elastase, F 25907-7

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
New Test 2022-11-15