SynthesisUnited European gastroenterology journal2025
Diagnostic Accuracy of Fecal Elastase-1 Test for Pancreatic Exocrine Insufficiency: A Systematic Review and Meta-Analysis.
Synthesis in United European gastroenterology journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Digestive enzyme replacement in very preterm infants: a prospective observational study.European journal of clinical nutrition · 2026Article
- Unique causes of exocrine pancreatic insufficiency: When to consider pancreatic enzyme supplementation: A narrative review.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2026Review
- Dietary Patterns Following an Episode of Acute Pancreatitis: A Post Hoc Analysis From the PAPPEI Multicenter, Prospective Study.Pancreas · 2026Article
- Utility of Fecal Elastase-1 in Estimating Exocrine Pancreatic Function in Cystic Fibrosis: A Scoping Review.Pediatric pulmonology · 2026Article
- Pancreatic exocrine insufficiency.EClinicalMedicine · 2026Review
- Assessment of Pancreatic Exocrine Insufficiency in Patients with Dyspepsia: Clinical Utility of the PEI-Test in Identifying and Monitoring Response to Enzyme Replacement Therapy.Journal of clinical medicine · 2026Article
- Mechanism-Based Management of Pain in Chronic Pancreatitis: An Integrated Narrative Review.Cureus · 2026Review
- Idiopathic chronic pancreatitis: clinical highlights.Therapeutic advances in gastroenterology · 2026Review
- Longitudinal assessment of pancreatic exocrine dysfunction in type 1 diabetes.World journal of diabetes · 2025Article
- [Exocrine Pancreatic Insufficiency in Hepatic Cirrhosis: a Cross-Sectional Study].Acta gastroenterologica LatinoamericanaArticle
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Authors and funding
5 authors.
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Abstract
introductionPancreatic exocrine insufficiency (PEI) results from a reduction in pancreatic secretion of enzymes, leading to malabsorption of nutrients, intestinal symptoms, nutritional deficiencies and related comorbidities. The diagnosis of pancreatic exocrine insufficiency should be based on digestive tests, mainly the coefficient of fat absorption (CFA), based on the quantification of 72 h fecal fat excretion (FFE). However, this test is rarely performed in clinical practice. Fecal elastase-1 (FE-1) is a simple and widely used alternative. This meta-analysis evaluates the diagnostic accuracy of fecal elastase-1 for the diagnosis of PEI diagnosed by CFA or 72h-FFE.
methodsA systematic search of databases was performed to identify studies evaluating fecal elastase-1 and CFA/FFE for the diagnosis of pancreatic exocrine insufficiency. Inclusion criteria required original studies with data on sensitivity, specificity and other diagnostic metrics. Two independent reviewers performed data extraction and quality assessment using the QUADAS-2 tool. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratio (DOR) were calculated and heterogeneity was assessed using I-squared tests.
resultsThirteen studies with 888 patients were included. Fecal elastase-1 at a cut-off of 200 μg/g showed a pooled sensitivity and specificity of 0.94 and 0.69, respectively, with a DOR of 35.27. Lowering the cut-off to 100 μg/g improved specificity to 0.82 but decreased sensitivity to 0.88. Subgroup analyses showed different diagnostic performance in different clinical contexts, with higher sensitivity in cystic fibrosis (0.98) and higher specificity in chronic pancreatitis (0.81). The positive and negative predictive values are limited in situations with low and high probability of pancreatic exocrine insufficiency, respectively.
conclusionsFecal elastase-1 is a sensitive and moderately specific diagnostic tool for pancreatic exocrine insufficiency and is suitable for initial screening in high-risk populations. However, its moderate specificity requires careful interpretation in lower risk settings.
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