Elastase stool test

Overview

The elastase stool test is a simple test that measures the level of a protein called elastase in your stool (poo). Elastase is made by the pancreas, an organ behind your stomach that helps digest food. Low levels of elastase in stool can mean your pancreas is not working as well as it should to produce digestive enzymes.

Elastase stool testing is a common diagnostic tool, especially for people with symptoms like greasy stools, weight loss, or long-standing belly pain. The conditions it checks for are not extremely common, but they are seen more often in people with chronic pancreatitis, cystic fibrosis, or after certain surgeries.

It is typically used for adults who have symptoms of poor digestion. It is also used in children with cystic fibrosis or suspected pancreatic problems.

Symptoms

Common symptoms

• Greasy, foul-smelling stools that float or are difficult to flush
• Unexplained weight loss even when eating well
• Bloating, gas, and stomach discomfort after meals
• Fatigue or feeling weak

Symptoms in children

• Failure to gain weight or grow as expected
• Large, pale, and smelly bowel movements
• Frequent stomach aches or bloating after eating

Symptoms in older adults

• Weight loss and muscle wasting
• Diarrhea or loose stools that do not go away
• Signs of vitamin deficiencies, such as easy bruising (vitamin K) or night blindness (vitamin A)

Causes

Main causes

• Chronic pancreatitis – long-term inflammation of the pancreas
• Cystic fibrosis – a genetic condition that affects mucus and digestive enzymes
• Blockage of the pancreatic duct (the tube that carries enzymes from the pancreas to the gut)
• Surgery to remove part of the pancreas
• Diabetes (especially type 1) that has affected the pancreas long-term

Risk factors

• Heavy alcohol use over many years
• Smoking
• Family history of cystic fibrosis or pancreatitis
• Certain autoimmune conditions (e.g., lupus, Sjögren’s syndrome)
• Having had gallstones or a severe attack of acute pancreatitis

When to see a doctor

See a doctor urgently if:

• If you have severe belly pain, especially with vomiting or fever, seek help right away.

Book a routine appointment if:

• If you have had greasy stools, unexplained weight loss, or bloating for several weeks, make an appointment with your GP.
• If you have known pancreatic disease and notice worsening symptoms.

Diagnosis

The elastase stool test is used to check for exocrine pancreatic insufficiency (EPI). Your doctor will ask about your symptoms and may order this test if they suspect your pancreas is not working properly. A low elastase level (usually less than 200 micrograms per gram of stool) suggests EPI.

Tests that may be done

• Elastase stool test (the key test)
• Blood tests to check for signs of inflammation, vitamin deficiencies, or diabetes
• Imaging such as a CT scan or MRI of the pancreas
• Sometimes a more detailed test called a fecal fat test

What to expect at your appointment

For the elastase stool test, you will collect a small sample of stool at home using a kit your doctor provides. You can return the sample to the lab the same day or as instructed. There is no special preparation needed. Results usually come back within a few days. The test does not cause any pain or discomfort.

Treatment

If the test shows you have low elastase (exocrine pancreatic insufficiency), treatment focuses on replacing the missing digestive enzymes. This helps you absorb nutrients properly and improves symptoms like greasy stools and weight loss.

Self-care at home

• Eat smaller, more frequent meals to ease digestion.
• Avoid high-fat, greasy foods if they trigger discomfort.
• Drink plenty of water, especially if you have diarrhea.
• Follow your doctor’s advice about vitamin supplements (such as vitamins A, D, E, and K).

Medical treatments

The main medical treatment involves taking pancreatic enzyme replacement therapy (PERT). These are capsules containing enzymes that digest fats, proteins, and carbohydrates. You take them with every meal and snack. Your doctor or a dietitian will guide you on the right dose. Some people also need medicines to reduce stomach acid, as this helps the enzymes work better.

When is surgery considered?

Surgery is rarely needed for EPI itself. However, if the cause is a blocked pancreatic duct or a growth in the pancreas, surgery may be considered to address that problem. Your specialist will discuss this if it applies.

Living with this condition

Managing pancreatic insufficiency involves taking enzyme capsules with everything you eat. Over time, this becomes a routine habit. You will learn which foods work best for you and how to adjust your enzyme dose with your healthcare team.

Lifestyle tips

• Keep a food and symptom diary to track what works.
• Plan ahead for meals when you are away from home – carry your enzymes with you.
• Avoid alcohol and smoking, as they can worsen pancreatic damage.
• Stay physically active to help maintain weight and strength.

Diet and exercise

Your dietitian may recommend a balanced diet with moderate fat, since enzymes help you digest fat. Eat plenty of vegetables, lean protein, and whole grains. Strength training or light exercise can help rebuild muscle lost from poor absorption.

Mental health and emotional wellbeing

Living with a chronic digestive condition can feel frustrating or isolating. You may feel anxious about eating in public or worry about symptoms. It is normal to feel this way – talking to a counsellor or joining a support group can help.

Prevention

You cannot always prevent conditions that cause low elastase, but you can reduce your risk of chronic pancreatitis by avoiding heavy alcohol use and not smoking. Managing conditions like diabetes and gallstones early may also help.

Screening programmes

There is no routine screening test for pancreatic insufficiency in the general population. If you have a family history of cystic fibrosis or chronic pancreatitis, your doctor may suggest testing earlier if symptoms arise.

Complications

If left untreated

• Severe weight loss and malnutrition
• Vitamin deficiencies (especially fat-soluble vitamins A, D, E, and K)
• Bowel symptoms that interfere with daily life
• Weak bones (osteoporosis) from poor calcium and vitamin D absorption

Long-term outlook

With proper treatment, most people with exocrine pancreatic insufficiency can manage their symptoms well, maintain a healthy weight, and live full lives. The condition often requires lifelong enzyme therapy, but it is effective and safe. Regular check-ups help keep you on track.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.