At a Glance

Why Get Tested?

To help detect and evaluate pancreatic insufficiency

When To Get Tested?

When you have signs and symptoms such as stomach cramps, weight loss, malnutrition, malabsorption, delayed growth (in children) and fatty, foul-smelling stools and pancreatic insufficiency is suspected

Sample Required?

A fresh formed stool sample that is not contaminated with urine

Test Preparation Needed?

If you are taking pancreatic enzymes, you may be asked to discontinue them for 5 days prior to stool collection.

Looking For Test Results?

Looking For Reference Ranges?

You may be able to find your test results on your laboratory’s website or patient portal. However, you are currently at Testing.com. You may have been directed here by your lab’s website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab’s website or portal, or contact your healthcare practitioner in order to obtain your test results.

Testing.com is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called “normal” values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are “within normal limits.”

For more information, please read the article Reference Ranges and What They Mean.

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 (feces) 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 tissues: 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 the sample collected for testing?

A stool sample is collected in a clean container. The sample should be formed (not watery) and not contaminated with urine or water. The container should be transported promptly to the laboratory, or the sample may be frozen for later transport.

Is any test preparation needed to ensure the quality of the sample?

If you are taking pancreatic enzymes, you may be asked to discontinue them for 5 days prior to stool collection.

Common Questions

How is it used?

The elastase test is used along with other tests, such as fecal fat and/or fecal 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 ordered?

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 test 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 diarrhea, 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.

How long will it take for results?

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 laboratory 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 fecal fat and chymotrypsin or blood tests for amylase and lipase to look at other aspects of pancreas and digestive function.

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 celiac 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.

Related Images

Location of the pancreas. Image credit: Don Bliss, National Cancer Institute
The pancreas and nearby organs and structures. Image credit: Don Bliss, National Cancer Institute

View Sources

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Lyon, E. et. al. (2016 December 16 Updated). Pancreatitis, Chronic – Chronic Pancreatitis. ARUP Consult. Available online at https://arupconsult.com/content/pancreatitis-chronic. Accessed on 3/19/17.

Levy, P. et. al. (2014 October). Epidemiology of chronic pancreatitis: burden of the disease and consequences. United European Gastroenterol J. 2014 Oct;2(5):345-54. Available online at https://www.ncbi.nlm.nih.gov/pubmed/25360312. Accessed on 3/19/17.

Schneider, A. et. al. (2005 May). Monoclonal versus Polyclonal ELISA for Assessment of Fecal Elastase Concentration: Pitfalls of a New Assay. Clinical Chemistry 51, No. 6, 2005. Available online at http://clinchem.aaccjnls.org/content/51/6/1052. Accessed on 3/19/17.

Kellerund, J. and Layer, P. (2015 September 14). Diagnosis of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreapedia: Exocrine Pancreas Knowledge Base, DOI: 10.3998/panc.2015.37. Available online at https://www.pancreapedia.org/reviews/diagnosis-of-pancreatic-exocrine-insufficiency-in-chronic-pancreatitis. Accessed on 3/19/17.

Bansal, R. (2017 February Revised). Chronic Pancreatitis. Merck Manual Professional Version. Available online at http://www.merckmanuals.com/professional/gastrointestinal-disorders/pancreatitis/chronic-pancreatitis. Accessed on 3/19/17.

Löhr, J. et. al. (2013 April). Synopsis of recent guidelines on pancreatic exocrine insufficiency. United European Gastroenterol J. 2013 Apr; 1(2): 79–83. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040730/. Accessed on 3/19/17.

Gheorghe, C. et. al. (2015 March). Romanian Guidelines on the Diagnosis and Treatment of Exocrine Pancreatic Insufficiency. J Gastrointestin Liver Dis, March 2015 Vol. 24 No 1: 117-123. Available online at http://www.jgld.ro/2015/1/21.html. Accessed on 3/19/17.

Pezzilli, R. et. al. (2013 November 28). Exocrine pancreatic insufficiency in adults: A shared position statement of the Italian association for the study of the pancreas. World J Gastroenterol. 2013 Nov 28; 19(44): 7930–7946. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848141/. Accessed on 3/19/17.

Guandalini, S. (2016 September 26 Updated). Chronic Pancreatitis. Medscape Drugs and Diseases. Available online at http://emedicine.medscape.com/article/181554-overview. Accessed on 3/19/17.

Duggan, S. et. al. (2016 February 21). Chronic pancreatitis: A diagnostic dilemma. World J Gastroenterol. 2016 Feb 21; 22(7): 2304–2313. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735004/. Accessed on 3/19/17.

Struyvenberg, M. et. al. (2017 February 10). Practical guide to exocrine pancreatic insufficiency – Breaking the myths. BMC Med. 2017; 15: 29. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301368/. Accessed on 3/19/17.

Lindkvist, B. (2013 November 14 Updated). Diagnosis and treatment of pancreatic exocrine insufficiency. World J Gastroenterol. 2013 Nov 14; 19(42): 7258–7266. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831207/. Accessed on 3/19/17.

Lüth, S. et. al. (2001 October). Fecal elastase-1 determination: ‘gold standard’ of indirect pancreatic function tests? Scand J Gastroenterol. 2001 Oct;36(10):1092-9. Abstract. Available online at https://www.ncbi.nlm.nih.gov/pubmed/11589385. Accessed on 3/19/17.

Ask a Laboratory Scientist

This form enables patients to ask specific questions about lab tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science. Please allow 2-3 business days for an email response from one of the volunteers on the Consumer Information Response Team.

Stool Elastase