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Author: Grafiati

Published: 11 March 2023

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1

Tóth, Anna Zsófia, András Szabó, Eszter Hegyi, Péter Hegyi, and Miklós Sahin-Tóth. "Detection of human elastase isoforms by the ScheBo Pancreatic Elastase 1 Test." American Journal of Physiology-Gastrointestinal and Liver Physiology 312, no. 6 (June 1, 2017): G606—G614. http://dx.doi.org/10.1152/ajpgi.00060.2017.

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Determination of fecal pancreatic elastase content by ELISA is a reliable, noninvasive clinical test for assessing exocrine pancreatic function. Despite the widespread use of commercial tests, their exact molecular targets remain poorly characterized. This study was undertaken to clarify which human pancreatic elastase isoforms are detected by the ScheBo Pancreatic Elastase 1 Stool Test and whether naturally occurring genetic variants influence the performance of this test. Using recombinantly expressed and purified human pancreatic proteinases, we found that the test specifically measured chymotrypsin-like elastases (CELA) 3A and 3B (CELA3A and CELA3B), while CELA2A was not detected. Inactive proelastases, active elastases, and autolyzed forms were detected with identical efficiency. CELA3B elicited approximately four times higher ELISA signal than CELA3A, and we identified Glu154in CELA3B as the critical determinant of detection. Common genetic variants of CELA3A and CELA3B had no effect on test performance, with the exception of the CELA3B variant W79R, which increased detection by 1.4-fold. Finally, none of the human trypsin and chymotrypsin isoforms were detected. We conclude that the ScheBo Pancreatic Elastase 1 Stool Test is specific for human CELA3A and CELA3B, with most of the ELISA signal attributable to CELA3B.NEW & NOTEWORTHY The ScheBo Pancreatic Elastase 1 Stool Test is widely used to assess pancreatic exocrine function, yet its molecular targets have been poorly defined. We demonstrate that, among the human pancreatic proteinases, the test measures the elastase isoform CELA3B and, to a lesser extent, CELA3A. Genetic variants of the human CELA3 isoforms have no significant effect on test performance.

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Akay, Sinan, Burcu Şirin, and Belkıs Ünsal. "Fecal Elastase Levels Predict Honeycombing in Pancreas Detected with Endoscopic Ultrasound." Canadian Journal of Gastroenterology and Hepatology 2018 (December 2, 2018): 1–4. http://dx.doi.org/10.1155/2018/4625247.

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Background and Study Aims. We aimed to demonstrate the association between fecal elastase levels and Rosemont categories in patients with chronic changes in pancreas detected with endoscopic ultrasound. Patients and Methods. Patients were selected consecutively from endosonography examinations performed for upper gastrointestinal subepithelial lesions and for pancreas evaluation. Pancreas imaging findings were categorized according to the Rosemont criteria using echoendoscope. Patients who were indeterminate of, suggestive of, and consistent with chronic pancreatitis were included in the study. Fecal elastase measurements were performed after the patients were qualified to participate in the study according to endosonography findings. Results. Seventy patients were included in the study. 54 of them were male. Mean age of the patients was 51.7 ± 10.2 year. There were 36 patients in the indetermine group for chronic pancreatitis. Mean fecal elastase level was 507.1 ± 14.6 μg/g in the indeterminate group. There were 24 patients in the suggestive group of chronic pancreatitis. Mean fecal elastase level was 400.4 ± 121.4 μg/g in the suggestive group of chronic pancreatitis. There were 10 patients, in the consistent group with chronic pancreatitis. Mean fecal elastase level was 134.8 ± 86.1. The difference between the three groups of fecal elastase values was statistically significant compared with Kruskal Wallis test. Ordinal logistic regression analysis showed that there was a significant relation between endosonografic categories and fecal elastase values with Nagelkerke value of 0.704. Conclusions. Fecal elastase levels of each of the endosonographic categories were significantly different from each other. Also, fecal elastase values can predict chronic changes in pancreas detected with endoscopic ultrasound.

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MATTAR, Rejane, Gustavo André Silva LIMA, Marianges Zadrozny Gouvêa da COSTA, Joyce M. Kinoshita SILVA-ETTO, Dulce GUARITA, and Flair José CARRILHO. "COMPARISON OF FECAL ELASTASE 1 FOR EXOCRINE PANCREATIC INSUFFICIENCY EVALUATION BETWEEN EX-ALCOHOLICS AND CHRONIC PANCREATITIS PATIENTS." Arquivos de Gastroenterologia 51, no. 4 (December 2014): 297–301. http://dx.doi.org/10.1590/s0004-28032014000400006.

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Context Fecal elastase is a noninvasive test for pancreatic insufficiency diagnosis. Objectives Evaluate the usefulness of fecal elastase 1 for the indication of exocrine pancreatic insufficiency among former alcohol addicts and patients with chronic pancreatitis. Methods Forty-three patients with chronic pancreatitis and thirty-three asymptomatic former alcohol addicts entered the study. The levels of fecal elastase 1 were measured using a commercial kit. Pancreatic imaging findings were used to categorize the groups. Results The levels of fecal elastase 1 were significantly lower in the patients than in the former alcohol addicts and in the group with tissue calcifications, duct alterations, or atrophy. With a cutoff level of 100 μg/g, the sensitivity of fecal elastase 1 in chronic pancreatitis was 46.51% and its specificity was 87.88% with a positive predictive value of 83.33% and a negative predictive value of 55.77%. When patients were stratified according to the severity of their pancreatitis, the sensitivity was 6.25% for mild pancreatitis and 70.37% for marked pancreatitis. Conclusion Low level of fecal elastase 1 was associated with marked rather than mild chronic pancreatitis; however, it may be useful to indicate pancreatic exocrine insufficiency in asymptomatic former alcohol addicts.

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4

Pei, Guanghui, Wu Lv, Xiaohang Li, Guoqing Zhang, and Jialin Zhang. "Influence of SPK with Enteric Drainage on the Pancreatic Exocrine Function in Diabetic Patients with Uremia." International Journal of Endocrinology 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/3709306.

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Objective. This study aimed to determine the use of fecal elastase in evaluating the effect of simultaneous pancreas–kidney transplantation with enteric drainage on the pancreatic exocrine function of diabetic patients with uremia.Methods. A total of 19 patients with simultaneous pancreas–kidney transplantation (SPK) with enteric drainage, 31 diabetic patients with uremia (chronic renal failure (CRF)), 22 diabetic patients with uremia who underwent renal transplantation (RT), and 20 normal individuals (CON) were included in the study. Pancreatic exocrine insufficiency was determined using fecal elastase. Results. The fecal pancreatic elastase level in SPK patients with enteric drainage was 479 μg/g, which was significantly higher than 229 μg/g in CRF patients and 197 μg/g in RT patients. Using 200 μg/g as the established threshold, a reduced fecal pancreatic elastase level was found in 14/31 of CRF patients, 12/22 of RT patients, 1/19 of SPK patients with enteric drainage, and 1/20 of CON patients. The correlation analysis revealed a significant association between fecal elastase and glycosylated hemoglobin.Conclusions. The present study indicated that SPK with enteric drainage improves pancreatic endocrine and exocrine functions. Fecal elastase may be a clinically relevant means to determine the therapeutic effects.

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5

Stein, J., M. Jung, A. Sziegoleit, S. Zeuzem, W. F. Caspary, and B. Lembcke. "Immunoreactive elastase I: clinical evaluation of a new noninvasive test of pancreatic function." Clinical Chemistry 42, no. 2 (February 1, 1996): 222–26. http://dx.doi.org/10.1093/clinchem/42.2.222.

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Abstract We have evaluated the diagnostic value of the fecal elastase test in comparison with the secretin-pancreozymin test in the diagnosis of exocrine pancreatic insufficiency. Pancreatic elastase was measured immunologically. Immunoreactive elastase activity in spot stools from controls ranged from 136 to 4440 microgram/g; 95% of all values were within 175 to 1500 microgram/g. The elastase assay CVs ranged from 3.3% to 6.3% (intraassay) and from 4.1% to 10.2% (interassay). The output of elastase correlated well with those of amylase, lipase, and trypsin, yielding respective correlation coefficients of 0.83, 0.82, and 0.84 in controls and 0.86, 0.91, and 0.91 in patients with impaired pancreatic function. In contrast to fecal chymotrypsin, the test results were unaffected by pancreatic enzyme replacement therapy. These results indicate that fecal immunoreactive elastase may be recommended as a new, noninvasive tubeless test of pancreatic function.

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6

Costa, Juliana Cana Brazil, and Edna Lúcia Souza. "Comparação de custos daterapia de reposição enzimática empírica com terapia guiada por diagnóstico laboratorial da insuficiência pancreática." Revista de Ciências Médicas e Biológicas 20, no. 3 (December 20, 2021): 387–93. http://dx.doi.org/10.9771/cmbio.v20i3.47079.

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Introdução: a fibrose cística, também conhecida como mucoviscidose, é uma doença genética cujas manifestações resultam da disfunção do gene cystic fibrosis transmembrane conductorance regulator. Cerca de 85% dos indivíduos com essa doença desenvolvem insuficiência pancreática exógena. Objetivo: comparar os custos da terapia de reposição enzimática empírica com a terapia de reposição enzimática empírica guiada pelo teste da elastase fecal, em indivíduos com fibrose cística, acompanhados em um centro de referência para assistência à doença. Metodologia: realizou-se um estudo descritivo e comparativo, que incluiu indivíduos de 0 a 21 anos, com fibrose cística. Coletaram-se dados referentes ao período de janeiro de 2016 a fevereiro de 2020, com registros clínicos, demográficos e laboratoriais. Inicialmente, com base em critérios clínicos, os participantes foram classificados como suficientes pancreáticos ou insuficientes pancreáticos. Após o resultado da dosagem da elastase fecal, o diagnóstico do status pancreático foi reavaliado. Realizou-se a estimativa dos custos do teste da elastase fecal por participante e da terapia por reposição enzimática empírica da insuficiência pancreática em indivíduos que, posteriormente, foram diagnostica dos como suficientes pancreáticos. Resultados: incluíram-se 50 participantes, com média de idade de 9,4 anos, sendo 52% do sexo masculino. Após o resultado da dosagem da elastase fecal, 7 participantes considerados insuficientes pancreáticos e foram reclassificados como suficientes pancreáticos. No período estudado, a economia média estimada, por participante suficiente pancreático, com a suspensão das enzimas, após resultado da elastase fecal, foi de R$ 6.770,13. Conclusão: a terapia de reposição enzimática empírica no tratamento da insuficiência pancreática pode levar a custos desnecessários. A medida de dosagem da elastase fecal contribui para decisão mais objetiva da avaliação da função pancreática

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Khasanova, S. S., A. T. Kamilova, and D. I. Akhmedova. "Fecal elastase activity in premature children." Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 64, no. 5 (November 16, 2019): 44–48. http://dx.doi.org/10.21508/1027-4065-2019-64-5-44-48.

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We studied the activity of fecal elastase in 54 premature newborns of a gestation period of 22–32 weeks. The samples of feces were collected at the age of 13–14 days. Premature children born at gestational age of 22–28 weeks had pancreatic insufficiency of light degree by 2 weeks of age, preterm infants with a gestational age of 28–32 weeks by 2 weeks of age had the values of pancreatic elastase equal to that of full-term children. The authors have established the relationship between the degree of pancreatic insufficiency and the gestational age of newborns. Fecal elastase activity was significantly lower in premature infants who received milk mixtures as compared to breast-fed infants or infants with mixed feeding. The study substantiated the necessity of early replacement therapy in such newborns to prevent exocrine pancreatic insufficiency.

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8

Steiner, J. M., J. F. Rehfeld, and N. Pantchev. "Evaluation of Fecal Elastase and Serum Cholecystokinin in Dogs with a False Positive Fecal Elastase Test." Journal of Veterinary Internal Medicine 24, no. 3 (March 15, 2010): 643–46. http://dx.doi.org/10.1111/j.1939-1676.2010.0489.x.

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9

Burkovskaya, V. A. "Exocrinous function of pancreas in Crohn’s disease patients." Bulletin of Siberian Medicine 8, no. 4 (August 28, 2009): 118–25. http://dx.doi.org/10.20538/1682-0363-2009-4-118-125.

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The functional state of pancreas in patients with the Crohn’s disease was studied. In feces of patients with CD, irritable colon syndrome, and healthy persons, the daily fat amount was determined by the van de Kamer’s method and fecal elastase-1 was determined using the immune-enzyme test with monoclonal antibodies (EIA system of BioServ Diagnostics, Elastase 1-ELISA, Germany). The fecal elstase-1 level in absolute and relative values in patients with CD decreases statistically confidently as the main disease becomes more severe.

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10

Kamilova, A. T., D. I. Akhmedova, Z. E. Umarnazarova, D. A. Abdullaeva, and S. I. Geller. "Concentration of fecal β-defensin-2 in children with cystic fibrosis: how the inneral intestinal immune response?" Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 66, no. 6 (January 20, 2022): 71–76. http://dx.doi.org/10.21508/1027-4065-2021-66-6-71-76.

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Cystic fibrosis is a disease caused by mutations in a gene encoding CFTR-protein (Cystic Fibrosis Transmembrane conductance Regulator), located in the apical membrane of epithelial cells of the respiratory tract, intestines and pancreas. Defensins serve as important components of the innate human immune system, they play a key role in providing the first line of defense of a macroorganism against infection; they have high antimicrobial, antiviral, cytotoxic activity.Objective. To determine the values of fecal β-defensin-2 in children with cystic fibrosis and to reveal the dependence of its level on the exocrine function of the pancreas and the severity of the patient’s condition.Characteristics of children and research methods. The study included 57 children with cystic fibrosis, the average age was 20.93 ± 2.9 months. Cystic fibrosis was diagnosed on the basis of an increase in immunoreactive trypsin, sweat chlorides by Cook’s method (>60 meq / l). To assess the exocrine function of the pancreas the scientists determined the activity of fecal elastase. They evaluated the levels of fecal β-defensin-2 and calprotectin using a quantitative enzyme immunoassay.Results. The levels of fecal β-defensin-2 were increased (108.2 ± 11.3 ng / ml) in all children under examination. The researchers found no correlation between the levels of fecal β-defensin-2 and fecal elastase. The level of fecal calprotectin was significantly higher in the group of children with cystic fibrosis as compared to the control group. There was a significant correlation between the levels of fecal calprotectin and fecal β-defensin-2 (r=0.57; p <0.05), however, no correlations were found between the levels of fecal β-defensin-2 and fecal elastase. The group of children with a severe course of the disease demonstrated an increase in the level of fecal β-defensin-2, fecal calprotectin significantly more frequent.Conclusion. Children with cystic fibrosis demonstrated a significant increase in the concentration of β-defensin-2 as compared to the control group, which confirms the activation of the innate immune system of the intestinal mucosa. The researchers traced the relationship between high levels of fecal β-defensin-2 and the severity of the disease. The levels of fecal β-defensin-2 directly correlated with the concentration of fecal calprotectin and there was no correlation between the severity of pancreatic insufficiency and the concentration of fecal β-defensin-2.

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11

WALKOWIAK, J., K. HERZIG, M. PAWLAK, M. KRAWCZYNSKI, and J. PRZYSLAWSKI. "Both fecal elastase-1 and fecal chymotrypsin concentrations are decreased i vegetarians." Gastroenterology 120, no. 5 (April 2001): A265. http://dx.doi.org/10.1016/s0016-5085(01)81314-7.

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12

Walkowiak, Jaroslaw M., Karl H. Herzig, Mikolaj Pawlak, Marian Krawczynski, and Juliusz Przyslawski. "Both fecal elastase-1 and fecal chymotrypsin concentrations are decreased i vegetarians." Gastroenterology 120, no. 5 (April 2001): A265. http://dx.doi.org/10.1016/s0016-5085(08)81314-5.

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13

Abdalla, E. M., A. S. Abd El-Hamid, F. Gobran, Z. M. Nooman, and A. M. Hassan. "Pancreatic fecal elastase in HCV associated liver disease." Biochemical Society Transactions 28, no. 5 (October 1, 2000): A153. http://dx.doi.org/10.1042/bst028a153b.

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14

Tod, Jo, and David Fine. "Fecal Elastase: A Useful Test for Pancreatic Insufficiency?" Digestive Diseases and Sciences 55, no. 10 (September 14, 2010): 2709–11. http://dx.doi.org/10.1007/s10620-010-1409-9.

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15

&NA;. "Assessment of exocrine pancreatic function by fecal elastase I." Pancreas 29, no. 1 (July 2004): 1. http://dx.doi.org/10.1097/00006676-200407000-00001.

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16

Weiss, Frank Ulrich, Christoph Budde, and Markus M. Lerch. "Specificity of a Polyclonal Fecal Elastase ELISA for CELA3." PLOS ONE 11, no. 7 (July 26, 2016): e0159363. http://dx.doi.org/10.1371/journal.pone.0159363.

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17

Icks, A., B. Haastert, G. Giani, and W. Rathmann. "Low fecal elastase-1 in type I diabetes mellitus." Zeitschrift für Gastroenterologie 39, no. 10 (October 2001): 823–30. http://dx.doi.org/10.1055/s-2001-17867.

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18

Holzapfel, Lindsay F., Amy B. Hair, Geoffrey A. Preidis, Tripti Halder, Heeju Yang, Jana P. Unger, Steven Freedman, and Camilia R. Martin. "Fecal Elastase in Preterm Infants to Predict Growth Outcomes." Journal of Pediatric Gastroenterology & Nutrition 76, no. 2 (December 1, 2022): 206–12. http://dx.doi.org/10.1097/mpg.0000000000003672.

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19

Malykh, Marina V., Elena A. Dubtsova, Lyudmila V. Vinokurova, Konstantin A. Les’ko, Alexey S. Dorofeev, Maria A. Kiryukova, Irina V. Savina, Victor V. Tsvirkun, and Dmitry S. Bordin. "Assessment of exo- and endocrine function of pancreas following distal pancreatectomy." Terapevticheskii arkhiv 94, no. 2S (September 5, 2022): 343–48. http://dx.doi.org/10.26442/00403660.2022.02.201386.

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Aim. The assessment of pancreatic resection volume influence on exo- and endocrine pancreatic functions. Materials and methods. The resected pancreatic volume influence was assessed in 47 patients: 31 (66%) patients after resections of pancreatic body and tail, and 16 (34%) patients after distal resections. The exocrine pancreatic function was assessed by pancreatic fecal elastase 1 as well as endocrine pancreatic function was assessed by C-peptide level measurement. Computed tomography with intravenous contrast enhancement and postprocessing was used for pre- and postoperative pancreatic volume assessment. All tests were performed before and 1, 3, and 6 months after surgery. Results. Type of surgery had no influence on C-peptide and pancreatic fecal elastase 1 levels (p0.05). Exo- and endocrine pancreatic functions markers tended to decrease in 1st month after surgery with consequent functions restoration towards 6 months after surgery. There were 15 (35.7%) patients from 42 patients with normal exocrine pancreatic function with a fecal elastase 1 level decrease to 114.761.8 g/g; exocrine insuficiency remained only in 2 (4.8%) patients after 6 months after surgery. C-peptide concentration decrease before surgery to less than 1.1 ng/ml was noticed only in 8 (17%) patients. C-peptide concentration decreased in 30 (63.8%) patients in 1st month after surgery, but after 6 months after surgery, C-peptide level decrease was only in 7 (14.9%) patients. Conclusion. The exo- and endocrine function of the pancreas is restored in more than 80% of patients after DR. Probably it could be associated with the activation of the pancreatic compensatory abilities.

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20

Galipeau, H. J., A. CAMINERO FERNANDEZ, W. Turpin, M. Bermudez-Brito, A. Santiago, J. Libertucci, M. Constante, et al. "A29 NOVEL FECAL BIOMARKERS THAT PRECEDE CLINICAL DIAGNOSIS OF ULCERATIVE COLITIS." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (March 1, 2021): 268–69. http://dx.doi.org/10.1093/jcag/gwab002.028.

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Abstract Background Altered gut microbiota composition and function has been associated with inflammatory bowel diseases (IBD) including ulcerative colitis (UC), but causality and mechanisms remain unknown. Most studies have examined patients with active or treated disease and little is known about microbial compositional or functional changes that occur before disease onset. Aims We studied a longitudinal cohort of subjects at risk for IBD to define the fecal microbial composition and function in subjects prior to UC onset (pre-UC) and at diagnosis (post-UC), and in matched at-risk subjects that remained healthy. Methods Fecal samples were collected from healthy individuals at-risk for IBD (pre-UC; n=13) and subjects were followed longitudinally until UC diagnosis (post-UC, n=9), at which point another fecal sample was collected. Fecal samples from a cohort of matched at-risk individuals that did not develop UC were used as healthy controls (n=48). We applied 16S rRNA gene sequencing, next generation shotgun sequencing, in vitro proteolytic assays and gnotobiotic colonizations to define the microbial composition and proteolytic function in fecal samples. Results The microbiota of post-UC subjects clustered separately from pre-UC and HC subjects, based on bray-curtis and unweighted UniFrac, had reduced alpha-diversity, and had reduced abundance of Aldercreutzia compared to pre-UC and HC. In vitro functional analysis revealed increased fecal proteolytic and elastase activity in pre-UC and post-UC samples compared to HC. Metagenomics identified pathways and gene families related to protein metabolism and proteases/peptides that were significantly different between HC and pre-UC samples, suggesting a bacterial component to the pre-UC proteolytic signature. Elastase activity inversely correlated with the relative abundance of Adlercreutzia, and other potentially beneficial taxa, and directly correlated with Bacteroides vulgatus, a known proteolytic taxon. High elastase activity was confirmed in Bacteroides isolates from fecal samples. Bacterial contribution and functional significance of the proteolytic signature was investigated in germ-free adults and litters born from dams colonized with HC, pre-UC or post-UC microbiota. Mice colonized with pre-UC microbiota at adulthood or neonatally developed higher fecal proteolytic activity and an inflammatory immune tone compared with HC colonized mice. Conclusions We have identified increased fecal proteolytic activity that precedes clinical diagnosis of UC and associates with gut microbiota changes. This may constitute a non-invasive biomarker of inflammation to monitor at-risk populations that can be targeted therapeutically with anti-proteases. Funding Agencies CAG, CCC, CIHR

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21

Fazylova, A. Sh, D. I. Akhmedova, A. T. Kamilova, and S. S. Khasanova. "Characteristic of exocrine function of the pancreas in premature newborns." Modern pediatrics. Ukraine, no. 2(114) (March 27, 2021): 21–25. http://dx.doi.org/10.15574/sp.2020.114.21.

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Premature babies in early postnatal ontogenesis are characterized by the immaturity of many functional systems, including the digestive system. The imperfection of the motor-evacuation function of the gastrointestinal tract in them is combined with insufficient activity of the enzyme systems, the peculiarities of the formation of the microbial landscape of the colon, which contributes to the development of digestive dysfunctions and complicates enteral feeding, especially in deeply premature infants. In order to determine the parameters pancreatic elastase (PE) in premature infants, depending on the gestational age and the nature of feeding, 135 newborns were examined (108 premature infants with a gestational age of 22 to 32 weeks and 27 term infants). All children underwent a general clinical examination, as well as a study for PE on the 13–14th day of life, when the volume of enteral nutrition reached 70 percent or more. Analysis of the study results revealed a clear relationship between the degree of prematurity and the severity of pancreatic insufficiency. A clear relationship between fecal elastase indicators and the type of feeding was determined. The most favorable situation is observed in exclusively breastfed children, who have the highest fecal elastase values, which practically do not differ from the control values. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: premature, elastase, pancreatic insufficiency.

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22

Tahtaci, Mustafa, Huseyin Koseoglu, Murat Alisik, Oyku Tayfur Yurekli, Gozde Tahtaci, Ozcan Erel, and Osman Ersoy. "Association of Low Fecal Elastase-1 and Non-Ulcer Dyspepsia." Journal of Clinical Medicine 7, no. 6 (June 16, 2018): 155. http://dx.doi.org/10.3390/jcm7060155.

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23

Battersby, I. A., I. R. Peters, M. J. Day, A. J. German, and E. J. Hall. "Effect of intestinal inflammation on fecal elastase concentration in dogs." Veterinary Clinical Pathology 34, no. 1 (March 2005): 49–51. http://dx.doi.org/10.1111/j.1939-165x.2005.tb00009.x.

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24

Walkowiak, Jaroslaw, and Karl-Heinz Herzig. "Evaluation of fecal elastase-1 concentrations in various malabsorption conditions." Gastroenterology 118, no. 4 (April 2000): A375. http://dx.doi.org/10.1016/s0016-5085(00)83607-0.

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25

Meyts, I., W. Wuyts, M. Proesmans, and K. De Boeck. "Variability of fecal pancreatic elastase measurements in cystic fibrosis patients." Journal of Cystic Fibrosis 1, no. 4 (December 2002): 265–68. http://dx.doi.org/10.1016/s1569-1993(02)00097-8.

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26

Sierra, C., J. Blasco, J. P. L??pez-Siguero, A. del Pino, M. Garc??a, and I. Vicioso. "P0823 PANCREATIC FECAL ELASTASE IN CHILDREN WITH TYPE 1 DIABETES." Journal of Pediatric Gastroenterology and Nutrition 39, Supplement 1 (June 2004): S370. http://dx.doi.org/10.1097/00005176-200406001-00947.

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27

Daftary, Ameet, James Acton, James Heubi, and Raouf Amin. "Fecal elastase-1: Utility in pancreatic function in cystic fibrosis." Journal of Cystic Fibrosis 5, no. 2 (May 2006): 71–76. http://dx.doi.org/10.1016/j.jcf.2006.01.005.

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28

Corvaglia, Luigi, Vittoria Paoletti, Barbara Battistini, Patrizia Simoni, and Giacomo Faldella. "Lack of Correlation Between Fecal Elastase-1 Levels and Fecal Nitrogen Excretion in Preterm Infants." Journal of Pediatric Gastroenterology and Nutrition 47, no. 5 (October 2008): 517–21. http://dx.doi.org/10.1097/mpg.0b013e3181615b4f.

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29

Chowdhury, Sudipta Dhar, Reuben Thomas Kurien, Anup Ramachandran, Anjilivelil Joseph Joseph, Ebby George Simon, Amit Kumar Dutta, Deepu David, Bharath Kumar C, Prassana Samuel, and K. A. Balasubramaniam. "Pancreatic exocrine insufficiency: Comparing fecal elastase 1 with 72-h stool for fecal fat estimation." Indian Journal of Gastroenterology 35, no. 6 (November 2016): 441–44. http://dx.doi.org/10.1007/s12664-016-0714-4.

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30

Sabat, Z. I., and L. S. Babinets. "Effect of autonomic dysfunction on the exocrine function of the pancreas in chronic pancreatitis." GASTROENTEROLOGY 56, no. 4 (February 12, 2023): 213–19. http://dx.doi.org/10.22141/2308-2097.56.4.2022.512.

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Background. The article evaluates the impact of autonomic dysfunction according to the heart rate variability data and the Spielberger-Khanin questionnaire on the exocrine function of the pancreas in chronic pancreatitis (CP). The aim is to evaluate the exocrine function of the pancreas depending on the heart rate variability and survey using the Spielberger-Khanin questionnaire. Materials and methods. One hundred outpatients with a diagnosis of CP who were treated in Ternopil healthcare institutions were examined. The presence of exocrine pancreatic insufficiency was determined by the level of fecal α-elastase. The psycho-emotional state was assessed using the Spielberger-Khanin questionnaire. Statistical and spectral indicators of heart rate variability were analyzed: the range of variation, the amplitude of the mode, stress index, indicator of activity of regulatory systems, total spectrum power, absolute and percentage values of very low frequency (VLF), low frequency (LF), high frequency power (HF), the LF/HF ratio. A correlation analysis was performed of the obtained heart rate variability data, the Spielberger-Khanin questionnaire data with the degree of exocrine pancreatic insufficiency in terms of the level of fecal α-elastase. Results. The average value of reactive anxiety on the Spielberger-Khanin questionnaire is 44.33 ± 0.89, personal anxiety is 43.19 ± 0.82, which corresponds to the upper limit of the moderate level. A negative correlation was found between these parameters and the level of fecal α-elastase (r = –0.482, p < 0.01, and r = –0.555, p < 0.01, respectively). Based on the heart rate variability of patients with CP, a tendency among them to sympathicotonia was detected, which was accompanied by a significant increase in the amplitude of the mode, stress index, the LF/HF ratio and a decrease in the range of variation compared to the control group. In contrast to the healthy individuals, the humoral-metabolic effect of heart rhythm regulation prevailed in those with CP (VLF — (48.66 ± 1.21) %) and the share of the nervous component (LF — (31.69 ± 0.67) %, HF — (19.65 ± 0.75) %) decreased, there was a significant decrease in the total power of the spectrum compared to the control group (1546.25 ± 44.18 versus 3155.65 ± 211.38). The indicator of the activity of regulatory systems in patients with CP (6.91 ± 0.12) was at the upper limit of the intense load of regulatory systems, which reflects a significant impairment of adaptation among them and reliably differs from the control level (3.90 ± 0.31). A significant correlation was found between the total power of the spectrum, indicator of the activity of regulatory systems and the level of fecal α-elastase (r = 0.511, p < 0.01, and r = –0.398, p < 0.01, respectively). Conclusions. During the study, it was found that with a deterioration in the psycho-emotional state (according to the data of the Spielberger-Khanin questionnaire), exocrine insufficiency of the pancreas in patients with CP increased: there was a correlation between the content of fecal α-elastase and the level of reactive and personal anxiety. Positive statistically significant correlations between the amplitude of the mode, stress index with the duration of the course of CP indicate compensatory activation of the sympathetic division of the autonomic nervous system. It was also proved that exocrine insufficiency (according to the content of fecal α-elastase) worsened with an increase in sympathicotonia (according to the stress index). A decrease in the functional reserve in patients with СР was revealed: a significant decrease in the total power of the spectrum was found compared to that of the control group; against this background, there was a decrease in the adaptive potential, deterioration in the psycho-emotional state, which resulted in an increase in exocrine pancreatic insufficiency. The obtained data motivate to improve the generally accepted comprehensive therapy of patients with chronic pancreatitis with the additional inclusion in it of agents to stabilize the autonomic nervous system.

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Fernández-Pérez, Silvia, Jenifer Pérez-Andrés, Sergio Gutiérrez, Nicolás Navasa, Honorina Martínez-Blanco, Miguel Ángel Ferrero, Santiago Vivas, et al. "The Human Digestive Tract Is Capable of Degrading Gluten from Birth." International Journal of Molecular Sciences 21, no. 20 (October 18, 2020): 7696. http://dx.doi.org/10.3390/ijms21207696.

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The human gastrointestinal system has the capacity to metabolize dietary gluten. The capacity to degrade gliadin-derived peptide is present in humans from birth and increases during the first stages of life (up to 6–12 months of age). Fecal samples from 151 new-born and adult non-celiac disease (NCD) volunteers were collected, and glutenase and glianidase activities were evaluated. The capacity of total fecal proteins to metabolize 33-mer, 19-mer, and 13-mer gliadin peptides was also evaluated by high-performance liquid chromatography (HPLC). Feces from new-borns (meconium) showed glutenase and gliadinase activities, and peptidase activity against all three gliadin peptides. Maximal gluten degradative activity was observed in fecal samples from the youngest volunteers (0–12 months old). After the age of nine months, the gluten digestive capacity of gastrointestinal tract decreases and, from ±8 years old, individuals lose the ability to completely degrade toxic peptides. The gastrointestinal proteases involved in gluten digestion: elastase 2A, elastase 3B, and carboxipeptidase A1 are present from earlier stages of life. The human digestive tract contains the proteins capable of metabolizing gluten from birth, even before starting gluten intake. Humans are born with the ability to digest gluten and to completely degrade the potentially toxic gliadin-derived peptides (33-, 19-, and 13-mer).

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Dozio, Nicoletta, Rita Indirli, Gian Maria Giamporcaro, Laura Frosio, Alessandra Mandelli, Andrea Laurenzi, Andrea Mario Bolla, et al. "Impaired exocrine pancreatic function in different stages of type 1 diabetes." BMJ Open Diabetes Research & Care 9, no. 1 (February 2021): e001158. http://dx.doi.org/10.1136/bmjdrc-2019-001158.

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IntroductionAim of this study was to investigate the pancreatic exocrine function in patients with type 1 diabetes (T1D) by multiple non-invasive tests.Research design and methodsThe study is a single-center, cross-sectional study of pancreatic exocrine function in adult patients with new-onset or long-standing T1D and healthy controls.ResultsHealthy controls, new-onset T1D, and long-standing T1D were similar for age at the time of the study, gender and body mass index (BMI) categories. Age of onset of T1D patients with long-standing disease was younger than that of patients with new-onset T1D (p<0.001). As expected, the three groups differed for C-peptide and hemoglobin A1c (HbA1c) levels. Lipase activity measured by 13C-mixed triglyceride breath test was reduced progressively, although not significantly, from controls to recent-onset T1D and long-standing T1D participants. Fecal elastase-1 was significantly lower in participants with T1D, either new onset or long standing. Pancreatic amylase, lipase, retinol binding protein and prealbumin were significantly different across the groups, with a significant trend toward lower values in long-standing T1D and intermediate values in new-onset T1D, while no differences were observed for total amylase. The markers of impaired exocrine function tests (fecal elastase-1, serum pancreatic amylase and lipase) and of nutritional status (retinol binding protein and prealbumin levels) correlated with the reduction of fasting and urinary C-peptide.ConclusionsOur results confirm that exocrine pancreatic impairment is a feature of T1D, with low fecal elastase-1, serum pancreatic amylase and lipase as specific markers, associated with reduced levels of nutritional indexes. Moreover, the evidence of more advanced insufficiency in long-standing disease reflects the chronic nature of this process, and its correlation with the residual β-cell function suggests parallel pathways for the impairment of the endocrine and exocrine pancreatic function.

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Foster, Timothy P., Brittany Bruggeman, Martha Campbell-Thompson, Mark A. Atkinson, Michael J. Haller, and Desmond A. Schatz. "EXOCRINE PANCREAS DYSFUNCTION IN TYPE 1 DIABETES." Endocrine Practice 26, no. 12 (December 2020): 1505–13. http://dx.doi.org/10.4158/ep-2020-0295.

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Objective: Type 1 diabetes (T1D) is characterized by autoimmune β-cell destruction, but exocrine pancreas abnormalities may also play a role in the disease pathophysiology. Herein, we review the current evidence of exocrine damage in T1D and discuss its underlying pathophysiology, clinical evaluation, and treatment. Method: Extensive literature search was performed for “type 1 diabetes” and “exocrine dysfunction” on PubMed and Google Scholar databases. Results: T1D pancreata are significantly smaller than controls, both in weight and volume. T cells, dendritic cells, neutrophils, and products of complement activation are seen in T1D exocrine tissues. Exocrine pancreas fibrosis, arteriosclerosis, fatty infiltration, and acinar atrophy are also observed on histology. Pancreatic exocrine insufficiency (PEI) can be assessed through direct exocrine testing, fecal elastase concentration, and measurement of serum exocrine enzymes. The prevalence of PEI in T1D varies by modality and study but is consistently greater than controls. The clinical relevance of PEI in T1D is debatable, as many patients with laboratory evidence of PEI are asymptomatic. However, in PEI-symptomatic patients reported benefits of pancreatic enzyme replacement therapy (PERT) include relief of gastrointestinal symptoms, improved quality of life, better glycemic control, and optimal nutrition. Conclusion: Exocrine pancreas abnormalities often occur in T1D. Whether exocrine dysfunction occurs simultaneously with β-cell destruction, as a result of β-cell loss, or as a combination of both remains to be definitively answered. In T1D with gastrointestinal complaints, PEI should be evaluated, usually via fecal elastase measurements. PERT is recommended for T1D patients with symptoms and laboratory evidence of PEI. Abbreviations: AAb+ = autoantibody positive; AAb− = autoantibody negative; FEC = fecal elastase concentration; PEI = pancreatic exocrine insufficiency; PERT = pancreatic enzyme replacement therapy; PP = pancreatic polypep-tide; T1D = type 1 diabetes

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Wali, Prateek D., Beth Loveridge-Lenza, Zhaoping He, and Karoly Horvath. "Comparison of Fecal Elastase-1 and Pancreatic Function Testing in Children." Journal of Pediatric Gastroenterology and Nutrition 54, no. 2 (February 2012): 277–80. http://dx.doi.org/10.1097/mpg.0b013e31820b0227.

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S. Lüth, S. Teyssen, K. Forssmann,. "Fecal Elastase-1 Determination: ?Gold Standard? of Indirect Pancreatic Function Tests?" Scandinavian Journal of Gastroenterology 36, no. 10 (January 2001): 1092–99. http://dx.doi.org/10.1080/003655201750422729.

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Garcia-Bueno, Carlos A., T. M. Rossi, Carlos A. Camacho, K. Widjaja Lee, G. Wang, and A. Tjota. "EVALUATION OF FECAL ELASTASE-1 CONCENTRATION IN CONDITION ASSOCIATED WITH MALABSORBTION." Journal of Pediatric Gastroenterology & Nutrition 27, no. 4 (October 1998): 489. http://dx.doi.org/10.1097/00005176-199810000-00124.

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Fischer, Bernhard P., Sven Hoh, Markus Wehler, Eckhart G. Hahn, and Thomas Schneider. "Pancreatic elastase-1 in fecal dry matter in health and disease." Gastroenterology 118, no. 4 (April 2000): A421. http://dx.doi.org/10.1016/s0016-5085(00)83795-6.

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Balaban, Daniel Vasile, Georgiana Robu, Andreea Zoican, Marina Ciochina, and Mariana Jinga. "Does fecal elastase correlate with EUS morphologic alterations of chronic pancreatitis?" Pancreatology 18, no. 4 (June 2018): S172. http://dx.doi.org/10.1016/j.pan.2018.05.465.

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Lira-Aguilar, A., G. Llibre, M. Vergara, M. Miquel, M. Casas, B. Dalmau, V. Puig-Divi, et al. "Prevalence of low levels of fecal elastase in decompensated cirrhotic patients." Pancreatology 20 (November 2020): S99—S100. http://dx.doi.org/10.1016/j.pan.2020.07.169.

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Anne, C., A. Hoppé, E. Troussier, E. Darviot, C. Pelatan, M. C. Chevalier, and J. L. Giniès. "246 Prognostic value of fecal elastase in children with Cystic Fibrosis." Journal of Cystic Fibrosis 5 (2006): S57. http://dx.doi.org/10.1016/s1569-1993(06)80223-7.

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41

Naruse, Satoru, Hiroshi Ishiguro, Shigeru B. H. Ko, Toshiyuki Yoshikawa, Takeshi Yamamoto, Akiko Yamamoto, Sachiko Futakuchi, Hidemi Goto, Yukio Saito, and Susumu Takahashi. "Fecal pancreatic elastase: a reproducible marker for severe exocrine pancreatic insufficiency." Journal of Gastroenterology 41, no. 9 (October 16, 2006): 901–8. http://dx.doi.org/10.1007/s00535-006-1884-0.

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Leeds, John S., Kofi Oppong, and David S. Sanders. "The role of fecal elastase-1 in detecting exocrine pancreatic disease." Nature Reviews Gastroenterology & Hepatology 8, no. 7 (May 31, 2011): 405–15. http://dx.doi.org/10.1038/nrgastro.2011.91.

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M, Abdul Rahman, Marcellus Simadibrata, Irsan Hasan, Suhendro Suhendro, and E. Mudjadid. "Difference in the Faecal Elastase-1 Concentration between Resectable and Unresectable Pancreatic Cancer." Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy 21, no. 2 (September 30, 2020): 99–107. http://dx.doi.org/10.24871/212202099-107.

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Background: In the pancreatic cancer can occur pancreatic exocrine insufficiency (PEI) that can be detected by measurement of fecal elastase-1 level. The aim of this study was to identify the proportion and the degree of PEI, proportion of steatorrhea in pancreatic cancer, the concentration difference of faecal elastase-1 between resectable and unresectable pancreatic cancer and mean concentration difference of faecal elastase-1 based on the stage of pancreatic cancer.Method: This was a cross-sectional study to determine the concentration difference of faecal elastase-1 between resectable and unresectable pancreatic cancer. This research was conducted at Cipto Mangunkusumo hospital, several network hospitals of Cipto Mangunkusumo hospital, and Wahidin Sudirohusodo Makasar hospital from November 2014 until May 2015. The statistical test used to assess differences in the levels of faecal elastase-1 between resectable and unresectable pancreatic cancer was Mann Whitney and Kruskal Wallis test was performed to assess the differences between the mean levels of faecal elastase 1 based on staging pancreatic cancer.Results: A total of 48 subjects with pancreatic cancer participated in this study, with resectable category was 19 (39.6%) subjects, and 29 (60.4%) subjects were unresectable. The proportion of patients with pancreatic cancer who experienced PEI was 75% (CI 95% 0.63 - 0.87) and the proportion of patients with pancreatic cancer who showed steatorrhea symptoms was 68.8% (CI 95% 0.557 - 0.819). There was no significant difference of faecal elastase-1 levels (P = 0.738) between the resectable and unresectable whereas the resectable group median value was 38.0 (15-500) μg/g and in unresectable group was 35.0 (15-500) μg /g. There was no significant difference (p = 0.767) in faecal elastase-1 levels based on the stage of pancreatic cancer with median (range) in stage IB 36 (15-100) pg/g, stage IIA 62 (15-500) pg/g, stage III 15 (15-500) μg/g, and stage IV 36 (15-500) μg/g.Conclusion: This study found a high proportion of PEI and steatorrhea in pancreatic cancer. There was no significant difference in faecal elastase-1 levels between the resectable and unresectable pancreatic cancer. There was no significant difference between mean levels of faecal elastase-1 based on the stage of pancreatic cancer.

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Girish, Banavara Narasimhamurthy, Gopalakrishna Rajesh, Kannan Vaidyanathan, and Vallath Balakrishnan. "Fecal elastase1 and acid steatocrit estimation in chronic pancreatitis." Indian Journal of Gastroenterology 28, no. 6 (November 2009): 201–5. http://dx.doi.org/10.1007/s12664-009-0079-z.

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Krylova, О. О. "Functional state of pancreas in patients with chronic pancreatitis." Herald of Pancreatic Club 43, no. 2 (May 3, 2019): 32–38. http://dx.doi.org/10.33149/vkp.2019.02.05.

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Аim of research is to study the functional state of the pancreas in patients with various forms of chronic pancreatitis. Materials and methods. Complex examination of 210 patients with various forms of chronic pancreatitis (І, n=26 — obstructive, ІІ, n=56 — calcifying, ІІІ, n=78 — fibrous-parenchymal, ІV, n=50 — chronic pancreatitis complicated by pseudocyst) was carried out. Activity of enzymes (amylase, lipase, trypsin, phospholipase A) in serum, duodenal and ductal pancreatic contents was determined by common clinical techniques. In addition, content of bicarbonates was determined in duodenal and ductal contents. Exocrine pancreatic function was assessed by fecal elastase-1 level, endocrine function — by glycosylated hemoglobin level. Results of study. Increased activity of enzymes was determined (amylase, lipase, trypsin, phospholipase A) in the serum of patients of all groups: amylase activity (61.6%), trypsin (85.9%) by 3.5 times and phospholipase A (84, 6%) — by 2.3 times in comparison with the control group (p <0,001). Most often, α-amylase activity increased in patients of I and IV groups (with the same frequency of 70.0%) due to the process exacerbation or obstacle for the pancreatic juice outflow; increased trypsin activity was more frequent in III group of patients (91,0%). According to the fecal elastase test, the highest degree of pancreatic parenchymal involvement was detected in II and III groups of patients. Fecal elastase test showed increased level of enzymes in the duodenal and ductal pancreatic contents, increased level of bicarbonates, and decrease in the exocrine pancreatic function. Inhibition of basal pancreatic secretion and increase of debit-hour of pancreatic enzymes in duodenal contents after stimulation of the pancreas was states, which corresponds to the intraoperatively obtained data. Conclusions. It was found out that functional activity of the pancreas was preserved in 83.3% of patients, which coincides with literature data on changes in the indices of pancreatic functional activity upon 90.0% lesion of its parenchyma.

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Walkowiak, J., K. H. Herzig, K. Strzykala, J. Przyslawski, and M. Krawczynski. "Fecal Elastase-1 Is Superior to Fecal Chymotrypsin in the Assessment of Pancreatic Involvement in Cystic Fibrosis." PEDIATRICS 110, no. 1 (July 1, 2002): e7-e7. http://dx.doi.org/10.1542/peds.110.1.e7.

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47

Teichmann, J., J. F. Riemann, and U. Lange. "Prevalence of Exocrine Pancreatic Insufficiency in Women with Obesity Syndrome: Assessment by Pancreatic Fecal Elastase 1." ISRN Gastroenterology 2011 (November 3, 2011): 1–5. http://dx.doi.org/10.5402/2011/951686.

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Background. Previous research on the combined association of 25-hydroxyvitamin D [25(OH)D] and exocrine pancreas insufficiency may have been limited by restricted age variability and a lack of representation of both body weight and body mass index. There are still too few conclusive reports about conspicuous vitamin D metabolism according to pancreatic fecal elastase 1 (FE1) in obese patients. Methods. Between May 2004 and July 2008, we investigated in 125 female patients with obesity syndrome at an average age of approximately 52.9 years as well as in age-matched 80 healthy female controls the prevalence of pancreas insufficiency. Serum levels of PTH, total calcium, and D3 vitamins calcitriol and calcifediol, as well as the concentration of fecal elastase 1 (FE1) were determined in patients and controls. Results. In 75 female nondiabetic patients with obesity syndrome (BMI 35≤40 kg/m2), calcifediol was markedly decreased (25.0±4.9 ng/mL) compared to controls (50.2±14.7 nmol/L; P<0.01). FE1 level was significantly decreased in obese subjects compared to controls ( P<0.01). Calcifediol was significantly lower in patients with morbid obesity (for calcifediol, P<0.05). Conclusion. In obese females, pancreatic FE1 in feces confirms the extent of vitamin D supply, and thus shows a vitamin D3 deficiency, depending on the loss of stool content. There seems to be a connection between the loss of exocrine function and the increasing body mass index. Pancreas insufficiency, as detected by low FE1 concentrations, is frequent in obese patients. However, the BMI is an additional factor for lowered fecal excretion of FE1.

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Amann, Stephen T., Michelle Bishop, Cheryl Curington, and P. P. Toskes. "Fecal Pancreatic Elastase 1 Is Inaccurate in the Diagnosis of Chronic Pancreatitis." Pancreas 13, no. 3 (October 1996): 226–30. http://dx.doi.org/10.1097/00006676-199610000-00002.

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Morera Ocón, F. J., L. Sabater Ortí, E. Muñoz Forner, J. Pérez Griera, B. Camps Vilata, and J. Ortega Serrano. "Does the type of pancreaticoenteric anastomosis influence fecal elastase levels after pancreaticoduodenectomy?" Pancreatology 13, no. 4 (July 2013): e6. http://dx.doi.org/10.1016/j.pan.2013.07.021.

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Rustemovic, Nadan, Silvija Cukovic-Cavka, Katja Grubelic Ravic, Dora Anzulovic, Martina Rojnic, Dunja Rogic, Roland Pulanic, and Boris Vucelic. "M1113 Pancreatic Insufficiency in Inflammatory Bowel Disease; Assesment By Fecal Elastase-1." Gastroenterology 136, no. 5 (May 2009): A—352—A—353. http://dx.doi.org/10.1016/s0016-5085(09)61616-4.

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