Understanding faecal elastase results

Overview

Faecal elastase is a simple test that measures the amount of an enzyme called elastase in your stool. Enzymes help your body digest food. Low levels of elastase in your stool can mean your pancreas is not making enough digestive enzymes. This is called pancreatic insufficiency. The test helps your doctor understand how well your pancreas is working.

This condition is not very common, but it occurs more often in people with certain pancreas problems, such as chronic pancreatitis or cystic fibrosis.

It can affect people of any age, but it is more common in adults who have a history of heavy alcohol use, smoking, or known pancreas disease. It also affects children with cystic fibrosis and some older adults with gradual pancreas damage.

Symptoms

Common symptoms

• Pale, oily, or greasy stools that may float or be hard to flush away
• Unexplained weight loss
• Belly bloating or gas after meals
• Loose or frequent bowel movements
• Belly pain or cramping

Symptoms in children

• Failure to gain weight or grow as expected
• Large, greasy, foul-smelling stools
• Frequent tummy aches
• Poor appetite

Symptoms in older adults

• Unintended weight loss
• Malnutrition or low vitamin levels
• Fatigue and weakness
• Diarrhoea or loose stools that do not go away

Causes

Main causes

• Chronic pancreatitis (long-term inflammation of the pancreas)
• Cystic fibrosis (a genetic condition affecting organs)
• Pancreatic cancer
• Surgery that removes part of the pancreas
• Long-term diabetes (type 1 and type 2)

Risk factors

• Heavy alcohol use over many years
• Smoking
• Family history of pancreas disease or cystic fibrosis
• Certain genetic mutations
• Autoimmune diseases that attack the pancreas

When to see a doctor

See a doctor urgently if:

• You have severe belly pain, fever, or jaundice
• You are losing a lot of weight without trying

Book a routine appointment if:

• You have ongoing diarrhoea, greasy stools, or bloating that does not go away
• You have a known pancreas condition and are due for a check-up

Diagnosis

Faecal elastase is diagnosed with a simple stool test. You will be asked to collect a small sample of your bowel movement in a special container. The sample is sent to a lab to measure the level of elastase.

Tests that may be done

• Faecal elastase test (stool test)
• Blood tests to check for vitamin deficiencies and markers of pancreas function
• Imaging tests such as an ultrasound, CT scan, or MRI of the pancreas
• A test called a 72-hour faecal fat measurement (rarely used now)

What to expect at your appointment

For the stool test, you may be asked to avoid using anti-diarrheal medicines for a few days before collecting the sample. The test is painless and done at home. You will receive instructions from your doctor or nurse. The result usually takes a few days. Your doctor will explain what the number means — normal is usually above 200 micrograms per gram, and low is below 200.

Treatment

Treatment focuses on replacing the digestive enzymes your pancreas is not making. This is called pancreatic enzyme replacement therapy (PERT). You take these enzymes with every meal and snack to help your body digest food and absorb nutrients. Treatment also involves managing the underlying cause, such as chronic pancreatitis or cystic fibrosis.

Self-care at home

• Take enzyme capsules as prescribed with every meal and snack — never skip a dose without talking to your doctor
• Eat smaller, more frequent meals to help your digestion
• Drink plenty of fluids throughout the day
• Avoid drinking alcohol and stop smoking — both can make pancreas damage worse
• Work with a dietitian to plan meals that are easy to digest and full of nutrients

Medical treatments

Doctors prescribe pancreatic enzyme replacement therapy (PERT) in the form of capsules or tablets. The dose is tailored to your needs based on how much enzyme your body lacks, the size of your meal, and your weight. You may also be given vitamins (especially fat-soluble vitamins A, D, E, and K) and minerals if you are deficient. If an underlying infection or autoimmune condition is causing your pancreas problem, your doctor may treat that with medicines such as antibiotics or steroids. Always follow your healthcare provider’s advice and never adjust your enzyme dose on your own.

When is surgery considered?

In some cases, surgery may be needed to treat the underlying cause, such as removing a blocked duct, a damaged part of the pancreas, or a tumour. Your doctor will discuss this option if it is appropriate for you.

Living with this condition

Living with pancreatic insufficiency means taking enzymes with everything you eat. Many people find it becomes a normal part of their routine. You will need to plan ahead when eating out or travelling. Carry your enzymes with you and store them as directed.

Lifestyle tips

• Always carry your enzyme capsules with you
• Keep a food diary to track symptoms and what works best for you
• Avoid high-fibre foods that can block enzymes — a dietitian can advise
• Stay physically active to maintain muscle strength and overall health

Diet and exercise

A balanced diet is essential. You may need extra calories and protein to prevent weight loss. Work with a dietitian to create a meal plan that suits your needs. Moderate exercise, such as walking or swimming, can help you stay strong and improve your mood.

Mental health and emotional wellbeing

Living with a chronic digestive condition can be stressful and sometimes embarrassing. You may feel anxious about eating in public or worried about your health. It is important to talk about these feelings with your doctor, a counsellor, or a support group. You are not alone, and help is available.

Prevention

Not all cases can be prevented, especially those caused by genetic conditions like cystic fibrosis. However, avoiding heavy alcohol use, not smoking, and managing conditions like diabetes can lower your risk of developing chronic pancreatitis, which is a common cause of low faecal elastase.

Vaccines

Vaccines are not available to prevent pancreatic insufficiency, but staying up to date with recommended vaccines (such as the flu jab and pneumonia vaccine) can help you stay healthy overall.

Screening programmes

Screening is not routinely done for the general public. However, if you have a family history of pancreatic disease or cystic fibrosis, your doctor may recommend genetic testing or monitoring.

Complications

If left untreated

• Malnutrition and unintended weight loss
• Vitamin deficiencies (especially vitamins A, D, E, and K)
• Osteoporosis (brittle bones) from poor calcium and vitamin D absorption
• Increased risk of infections due to poor nutrition

Long-term outlook

With proper treatment — including enzyme replacement and good nutrition — most people with pancreatic insufficiency can lead a full, active life. Symptoms improve, and weight often stabilises or increases. The outlook also depends on the underlying cause, but early diagnosis and management make a big difference. Stay in close contact with your healthcare team, and don't hesitate to ask for help when you need it.

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