Usefulness of faecal elastase-1 assay in monitoring pancreatic function in childhood coeliac disease

Background. In coeliac disease it has been demonstrated that the indirect pancreatic function tests detect a greater percentage of subjects with exocrine pancreatic insufficiency than the secretin-caerulein test. Aims. To evaluate faecal pancreatic elastase-1 assay in monitoring patients with coeliac disease. Patients, Thirty patients with coeliac disease (11 m; age range 1-7 years) completed a 2-month follow-up. As controls, we studied true sex-, age-matched patient groups: a) 15 patients with cystic fibrosis, b) 40 surgical patients without gastroenterological disease. Methods, In all coeliac subjects, stools were collected over 24 hours at diagnosis and then 30 and 60 days after commencement of the gluten-free diet; on a sample of the faeces we assayed elastase-1 activity. In the control patients, faeces were collected over 24 hours for elastase-1 assay only once. The coeliac patients only underwent the secretin-caerulein test, at diagnosis. Results. Ten out of 30 coeliac patients (33%) had subnormal faeca2 elastase-1 values at diagnosis, while all the surgical controls had values within the normal range; median values in coeliac patients were significantly lower than those of the surgical controls (median 287 mcg/g, 95% CI 271-430, versus 487 mcg/g, 95% CI 426-538, p<0.007). Cystic fibrosis patient values (median 10 mcg/g, 95% CI 7-155) were significantly lower than both those of coeliac patients and those of the surgical controls (p<0.0001). The secretin-caerulein test showed that 7/30 coeliac patients (23%) had a deficiency in one or more pancreatic enzymes; all these subjects had below normal faecal elastase-1 values. During the follow-up, we observed a progressive reduction in the number of coeliacs with pancreatic impairment; however; after 2 months of gluten-free diet, faecal elastase-1 deficiency persisted in 2/30 coeliacs. Conclusions. Faecal elastase-1 determination in coeliac patients reveals a similar frequency and duration of pancreatic impairment to those observed in studies performed using the faecal chymotrypsin assay; a reduction in faecal elastase-1 values can be linked to "non-typical pancreatic diseases".