Faecal elastase

Overview

A faecal elastase test measures the amount of an enzyme called elastase in your stool (poo). This enzyme is made by your pancreas and helps you digest food. Low levels can mean your pancreas isn't working well enough to make the enzymes you need for digestion.

This test is commonly performed when a person has symptoms of poor digestion, such as fatty, foul-smelling stools, unexplained weight loss, or ongoing bloating.

It affects people of all ages who may have a problem with their pancreas, including those with chronic pancreatitis, cystic fibrosis, or after pancreatic surgery.

Symptoms

Common symptoms

• Frequent, loose, pale, greasy stools that are hard to flush
• Unexplained weight loss despite eating well
• Abdominal bloating and gas after meals
• Stomach pain or discomfort
• Feeling very tired or weak

Symptoms in children

• Poor growth or failure to gain weight
• Large, greasy, and foul-smelling stools
• Frequent tummy aches
• Fussiness or irritability around feeding

Symptoms in older adults

• Loss of appetite and unintentional weight loss
• Changes in bowel habits, often mistaken for ageing
• General weakness and difficulty moving around
• Poor absorption of vitamins leading to brittle bones or easy bruising

Causes

Main causes

• Chronic pancreatitis – long-term inflammation that damages the pancreas
• Cystic fibrosis – a genetic condition that affects mucus production and can block the pancreas
• Pancreatic cancer – tumours that interfere with enzyme production
• Previous pancreatic surgery, such as removal of part or all of the pancreas
• Severe acute pancreatitis that does not heal properly

Risk factors

• Heavy and long-term alcohol use
• Smoking cigarettes
• Family history of pancreatic disease or cystic fibrosis
• Certain genetic conditions (e.g., Shwachman-Diamond syndrome)
• Having diabetes, especially type 1 diabetes for many years

When to see a doctor

See a doctor urgently if:

• If you have sudden, very bad abdominal pain that does not go away
• If you are vomiting and cannot keep fluids down
• If you have a fever along with belly pain and chills

Book a routine appointment if:

• If you have had greasy, loose stools for more than a week
• If you are losing weight without trying
• If you feel very bloated or have gas after almost every meal

Diagnosis

The first step is usually a faecal elastase test. You will be asked to provide a small stool sample. The lab checks how much elastase is present – very low levels strongly suggest the pancreas is not making enough digestive enzymes. Your doctor may also order blood tests or imaging scans to look for the underlying cause.

Tests that may be done

• Faecal elastase test – the main stool test for pancreatic function
• Blood tests to check for nutritional deficiencies and markers of pancreatitis
• Abdominal ultrasound, CT scan, or MRI to look at the shape of your pancreas
• Sometimes a test called a 'pancreatic function test' using a special drink or tube

What to expect at your appointment

For the faecal elastase test, you simply collect a small amount of stool in a clean container provided by your clinic. There is no special diet or preparation needed. The sample is sent to a lab, and results usually come back within a week. No needles or pain are involved.

Treatment

Treatment focuses on replacing the digestive enzymes your pancreas is missing and managing the cause of the problem. The main approach is taking pancreatic enzyme supplements with meals and snacks.

Self-care at home

• Eat smaller, more frequent meals to reduce the workload on your digestive system
• Avoid high-fat foods if they worsen your symptoms, but do not cut out fat completely unless advised
• Drink plenty of water to stay hydrated

Medical treatments

Your doctor may prescribe pancreatic enzyme replacement therapy (PERT). These are capsules containing the enzymes your pancreas would normally make. You swallow them with every meal and snack. Dose is individualised. Additionally, you may need vitamin supplements (especially fat-soluble vitamins A, D, E, K) if you have deficiencies. If your symptoms are caused by inflammation, pain medicines or stopping alcohol may be advised. Do not take over-the-counter digestive enzymes without consulting your healthcare provider – they vary in strength and may not be right for you.

When is surgery considered?

Surgery is rarely needed for the low elastase itself. However, if the cause is a blocked duct, a cyst, or pancreatic cancer, an operation may be recommended. Your specialist will discuss this if relevant.

Living with this condition

Living with pancreatic insufficiency means planning meals around taking enzyme supplements. You will need to take them at the start of every meal and sometimes with large snacks. Many people find that with proper treatment, their symptoms improve greatly and they can eat a fairly normal diet.

Lifestyle tips

• Stop smoking – it worsens pancreatic damage
• Limit or avoid alcohol completely, especially if you have pancreatitis
• Keep track of your weight and report any changes to your doctor

Diet and exercise

A balanced diet rich in calories, protein, and healthy fats is important, but you must take enzyme supplements to absorb them. Work with a dietitian if needed. Regular gentle exercise, like walking, can help maintain strength and prevent muscle loss. Avoid very heavy lifting if you have active abdominal pain.

Mental health and emotional wellbeing

Dealing with chronic digestive problems can be frustrating and stressful. You may feel anxious about eating in social settings or worried about your health. It's normal to feel this way. Talking to a counsellor or joining a support group can help you cope.

Prevention

You cannot always prevent pancreatic insufficiency, especially if it is due to genetics or an unavoidable condition like cystic fibrosis. However, avoiding heavy alcohol use, not smoking, and eating a healthy diet may lower your risk of chronic pancreatitis, which is a common cause.

Screening programmes

There is no routine screening for the general population. If you have a strong family history of pancreatic disease or cystic fibrosis, talk to your doctor about whether earlier testing makes sense for you.

Complications

If left untreated

• Severe weight loss and malnutrition
• Deficiencies in fat-soluble vitamins (A, D, E, K) leading to bone thinning, vision problems, or easy bleeding
• Steatorrhoea – greasy, foul-smelling diarrhoea that can cause embarrassment and dehydration
• Increased risk of bone fractures (osteoporosis) due to poor calcium and vitamin D absorption

Long-term outlook

With the right treatment, most people with pancreatic insufficiency can lead full, active lives. Enzyme supplements help your body absorb nutrients, and symptoms often improve dramatically. Staying in close touch with your healthcare team and following your treatment plan is key. Many people manage the condition well for many years.

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