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What is being tested?

Elastase is an enzyme produced by special (exocrine) tissue in the pancreas. This test measures the amount of elastase in stool (faeces) to help evaluate whether a person's pancreas is functioning properly.

The pancreas is an organ located in the abdomen that consists of two kinds of tissue: exocrine and endocrine. The exocrine pancreas is responsible for producing elastase along with other enzymes that are transported to the small intestine to break down fats, proteins, and carbohydrates as part of food digestion.

In the digestive tract, elastase is not broken down by other enzymes and is eventually eliminated from the body in the stool. Elastase can be detected and measured in the stool when a person's pancreas is functioning normally. The level in the stool is decreased when the exocrine tissues of the pancreas are not producing sufficient elastase and other digestive enzymes. This condition is called exocrine pancreatic insufficiency.

Exocrine pancreatic insufficiency occurs when the amount of enzymes released and transported to the small intestine is inadequate for proper food digestion and absorption of nutrients. Any condition that blocks the pancreatic ducts or damages or destroy the cells that produce elastase can cause pancreatic insufficiency. It is often seen in conditions such as chronic pancreatitis and sometimes pancreatic cancer. In children, it is most frequently associated with cystic fibrosis (CF) or Shwachman-Diamond syndrome (SDS). 

How is it used?

The elastase test is used along with other tests, such as faecal fat and/or faecal chymotrypsin, to evaluate both children and adults for pancreatic insufficiency.

Pancreatic insufficiency is the inability of the pancreas to produce and/or transport enough digestive enzymes to break down food in the intestine and aid in the absorption of nutrients. It typically occurs as a result of ongoing and worsening pancreatic damage.

The elastase test is most effective at detecting severe insufficiency and not as effective for mild or moderate forms.

When is it requested?

An elastase test may be ordered when a person has signs and symptoms of pancreatic insufficiency, such as:

  • Abdominal cramps and bloating
  • Foul-smelling, bulky, greasy stools
  • In children, an inability to gain weight, delayed growth
  • Malabsorption
  • Malnutrition
  • Vitamin deficiencies
  • Weight loss

What does the result mean?

A normal amount of elastase will be present in the stool of healthy individuals.

A decreased amount of stool elastase may mean that the person tested has pancreatic insufficiency. It is not diagnostic, but it does indicate that further testing may be indicated.

Is there anything else I should know?

A stool that is watery, such as with diarrhoea, is not a good sample as the water in the stool will dilute the elastase and decrease the amount measured.

If there are not enough pancreatic enzymes (and bile from the liver) available, then fat and other foods cannot be properly digested. If a condition prevents the intestines from absorbing nutrients, then they are "lost" by elimination in the stool. In both cases – improper digestion or absorption – the affected person can experience symptoms associated with malabsorption and, in severe cases, symptoms of malnutrition and vitamin deficiency.

People with pancreatic dysfunction often need to be monitored closely by their healthcare practitioner. They may find symptom relief and nutritional improvement from prescribed enzymes taken by mouth (oral) and vitamin supplements.

Common questions

  • How long will it take for results to be available?

This depends on the laboratory performing the testing. Not all laboratories offer this test and your sample may need to be sent to a reference laboratory for testing. It may take several days for results to be available.

  • What other lab tests might be done if I or my child has a normal elastase test?

If your signs and symptoms continue and a strong suspicion of pancreatic insufficiency remains, your healthcare practitioner may order stool tests for faecal fat and chymotrypsin or blood tests for amylase and lipase to look at other aspects of pancreas and digestive function. To learn more, read the article on Pancreatic Insufficiency.

  • What causes pancreatic insufficiency?

Pancreatic insufficiency can be caused by regular bouts of acute pancreatitis or by chronic pancreatitis. It is less frequently but sometimes associated with pancreatic cancer. Other causes of insufficiency may include coeliac disease, Crohn disease, autoimmune pancreatitis (immunoglobulin G4-related disease), Zollinger-Ellison syndrome, and some surgical procedures that can lead to a decrease in digestive system or pancreatic function.

In children, pancreatic insufficiency is most frequently associated with cystic fibrosis (CF) or Shwachman-Diamond syndrome (SDS). SDS is the second most common cause of inherited pancreatic insufficiency, after CF. All those with SDS have some degree of pancreatic insufficiency beginning in infancy.

Additionally, people who are carriers of one mutated copy of the CFTR gene, the gene typically responsible for cystic fibrosis, may have pancreatic insufficiency and experience the associated signs and symptoms. (See the article on CF Gene Mutations Testing to learn more about carriers.)

Last Updated: Thursday, 1st June 2023

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