Littérature scientifique sur le sujet « Elastasi fecale »

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.

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.

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.

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.

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.

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

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.

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.

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.

Introdução e objetivo: Elastase-1 fecal (EL-1) é um teste não invasivo que serve para avaliar a função pancreática exócrina. Neste estudo, buscou-se avaliar e quantificar a concentração da EL-1 fecal em pacientes com Fibrose Cística (FC), portadores da mutação ΔF508, e padronizar o teste Elastase monoclonal para a população estudada. Métodos: Estudo transversal prospectivo, com pacientes portadores de FC. Foram coletadas amostras de fezes para a quantificação da concentração da EL-1fecal pelo teste ELISA. A avaliação antropométrica baseou-se no percentil de IMC para crianças de 2 a 18 anos e percentil de P/E para crianças menores de 2 anos. Foi feita uma revisão nos prontuários dos pacientes para identificar a mutação da FC e coletar informações a respeito da dose da enzima administrada. Os desfechos analisados foram a insuficiência pancreática exócrina (IP) e sua intensidade, definida pela atividade da EL-1 fecal < 200μg/g. Resultados: Cinquenta e um pacientes com idade entre 4 meses e 17 anos participaram do estudo, divididos em 3 grupos: 17 homozigotos, 17 heterozigotos e 17 não ΔF508. A média de idade foi de 9,11 anos (± 4,74) e 62,8% eram do sexo masculino. As enzimas pancreáticas foram utilizadas em 46 pacientes (90,2%). Pacientes com o teste da EL-1 fecal com valores abaixo de 100μg/g representaram um total de 80,4% (n=41), sendo 17 homozigotos (41,5%), 14 heterozigotos (34,1%) e 10 com ausência de ΔF508 (24,4%). Houve associação estatisticamente significativa entre os homozigotos e a concentração da EL-1 fecal < 100μg/g. Todos os pacientes considerados IP pelo teste da EL-1 fecal faziam terapia de reposição enzimática (41 - 100%). Dez pacientes (19,6%) estavam com concentração da EL-1 fecal >200μg/g e, desses, 5 utilizavam enzimas pancreáticas. Onze pacientes (21,6%) apresentaram-se desnutridos, 10 (19,6%) em risco nutricional e 30 (58,8%) eutróficos. Não houve relação estatisticamente significativa entre estado nutricional, mutações e IP. Conclusões: A atividade de EL-1 fecal < 100 μg/g, indicativa de IP grave pelo teste, foi observada em 17/17 (100%) pacientes homozigotos para a mutação ΔF508 e em 14/17 (82,3%) heterozigotos para a mesma mutação. Não houve relação entre os valores de EL-1 fecal e o estado nutricional, avaliados pelo percentil do P/E para < 2 anos e percentil do IMC para >de 2 anos. O teste EL-1 fecal é de fácil execução e pode ser feito com uma pequena amostra de fezes; neste estudo, revelou-se útil na avaliação pancreática dos pacientes com FC.
Introduction and Objective: The fecal Elastase-1 (EL-1) is a noninvasive test used to assess exocrine pancreatic function. This study aims to assess and quantify the concentration of fecal Elastase -1 in patients with cystic fibrosis ΔF508 mutation carriers and to standardize the testing Elastase monoclonal test in our study group. Methods: Cross-sectional study with patients diagnosed with Cystic Fibrosis, being treated by the Hospital de Clínicas de Porto Alegre. Feces were collected for the quantification of Elastase concentration by ELISA. Nutritional assessment was calculated by percentile of BMI for children aged 2 to 18 years and percentile P / E for children under 2 years. Patient charts were reviewed to identify the cystic fibrosis mutation and to collect information about the dose of enzyme administered. The results analyzed were the exocrine pancreatic insufficiency and its intensity, defined by the activity of fecal EL-1 <200μg/g. Results: Fifty-one patients with ages ranging from 4 months to 17 years participated in the study and were divided into 3 groups: 17 homozygotes, 17 heterozygotes and 17 non ΔF508. The average age was 9.11 years (± 4.74) and 62.8% were male. The pancreatic enzymes were used in 46 (90.2%) patients. Patients with Elastase test with values below 100μg/g represented a total of 80.4% (n = 41) and 17 (41.5%) homozygous, 14 heterozygous (34.1%) and 10 with no ΔF508 (24.4%). There was a statistically significant association between the homozygous and the concentration of fecal EL-1 <100μg/g. All patients identified as PI by the EL-1 fecal test were in enzyme replacement therapy 41 (100%). Ten patients (19.6%) had a concentration of EL-1 fecal >200 μg / g, and 5 of pancreatic enzymes used. Eleven (21.6%) patients were malnourished, 10 (19.6%) were at nutritional risk and for 30 (58.8%) the nutritional status was normal. There was no significant relationship between nutritional status, mutations and pancreatic insufficiency. Conclusion: The activity of EL Fecal -1 <100 μg/g indicative of severe PI by the test, was observed in 17/17 (100%) patients homozygous for the mutation ΔF508 and 14/17 (82.3%) heterozygous for the same mutation. There was no association between the levels of fecal EL-1 and nutritional status assessed by the percentile of the P/E < 2 years and BMI percentile for >2 years. The fecal Elastase-1 test can be easily performed with a small stool sample and proved useful in the pancreatic evaluation of patients with cystic fibrosis.

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A Fibrose Cística é uma doença genética autossômica recessiva que leva a alterações da síntese ou função da proteína CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) aumentando a viscosidade das secreções, levando à perda progressiva da função pulmonar, pancreática e de outros órgãos que expressam a proteína CFTR. O objetivo desse trabalho é avaliar o perfil clínico e laboratorial de 125 pacientes pediátricos e adultos, com fibrose cística, atendidos no Estado Espírito Santo, Brasil, por meio de um estudo epidemiológico, observacional, descritivo, transversal e retrospectivo. Foram analisados os dados sociodemográficos, clínicos e laboratoriais com pacientes, sendo 87 crianças e 38 adultos com idade variando de dois a 80 anos e mediana de 14 anos, sendo 56% do sexo masculino e foram diagnosticados desde o primeiro mês de vida até 73 anos de idade, todos atendidos no Hospital Infantil Nossa Senhora da Glória e no Hospital Dório Silva, no Espírito Santo entre 1° de janeiro a 31 de dezembro de 2015. Para a análise estatística foi utilizado o programa SPSS para Windows versão 23.0, usando o nível de significância p<0,05 e intervalo de confiança de 95%. A dosagem média do cloreto no suor foi de 95,58 mEq/L e a elastase fecal média foi de 201,9 mg/g de fezes, sendo que no grupo pediátrico a média foi de 167 mEq/L. A desnutrição foi observada em 33 pacientes e sintomas respiratórias em 80,8%. Staphylococcus aureus que foi registrado mais na faixa etária pediátrica e Pseudomonas aeruginosa em adultos. Alfadornase foi prescrita em 84,8%, e enzimas em 68% dos pacientes. A dosagem do cloreto no suor mostrou uma relação inversamente proporcional com os valores laboratoriais da elastase fecal (p<0,001) e diretamente proporcional à idade do diagnóstico menor que dois anos (p<0,001) e com a variável radiológica do escore de Shwachman Kulczycki e não apresentou significância com mutações do gene CFTR delta F508 (p=0,585). A elastase fecal, também, apresentou significância estatística com a idade de diagnóstico menor de dois anos (p<0,001). Utilizando-se o ponto de corte do cloreto no suor em 90 mEq/L e se obteve uma área sob a curva ROC de 0,748 (p<0,001) e uma sensibilidade de 67,3% e especificidade de 38,6%. Percebeu-se que altas dosagens de cloreto no suor podem indicar maior risco de insuficiência pancreática em pacientes com fibrose cística, devendo o profissional de saúde pesquisar precocemente comprometimento do pâncreas, possibilitando reposição das enzimas pancreáticas, podendo melhorar a qualidade de vida e evitar complicações da Fibrose Cística. Mais trabalhos são necessários para confirmar a correlação entre a dosagem do cloreto no suor e a elastase fecal. Palavras-chaves: Fibrose Cística. Insuficiência Pancreática Exócrina. Cloro. Regulador de Condutância Transmembrana em Fibrose Cística.

Introduzione L’anastomosi del pancreas residuo con il tratto digestivo dopo duodenocefalopancreasectomia (DCP) rimane un aspetto critico nella gestione del paziente operato che può condizionare molteplici variabili che vanno dalla qualità di vita allo sviluppo di insufficienza pancreatica esocrina. Spesso la tecnica standard di pancreo-digiuno-anastomosi (PJ) viene sostituita dalla pancreo-gastro-anastomosi (PG), di più facile esecuzione e gravata da minori complicanze. Ad oggi non esiste nessuno studio a lungo termine di comparazione tra i due tipi di anastomosi. Materiali e Metodi. Lo studio è stato condotto su 31 pazienti operati di DCP per neoformazione pancreatica, papillare o per pseudotumor infiammatorio, dal 2001 al 2006. Tutti sono stati ospedalizzati e sottoposti a studi morfologici e di funzione. I parametri studiati sono stati il volume pancreatico ed il diametro del dotto pancreatico principale (MRI), la funzione esocrina del pancreas (grassi fecale, elastasi fecale e vitamina D) e la funzione endocrina. La qualità di vita e gli score sintomatologici sono stati valutati tramite il questionario EORTC QLQ-C30. E’ stata riportata la media ± 1 errore standard. La normalità della distribuzione è stata indagata mediante il test di Kolmogorov-Smirnov e la correlazione tra variabili indipendenti tramite test di Bravais-Pearson. Risultati. Sono stati studiati 31 pazienti, 15 con PG, 16 a PJ. Nessuna differenza è stata riscontrata in durata del follow-up, BMI, funzione endocrina, score sintomatologici e qualità di vita. La funzione esocrina del pancreas risulta più alterata dopo PG che dopo PJ (steatorrea 26.6±4.1 vs 18.2±3.6 g/die; FE-1 170.2±25.5 vs 121.4±6.7 μg/g). Vi è una netta riduzione di vitamina D (maggiore nelle PG rispetto alle PJ) (18.1±1.8 vs 23.2±3.1 ng/ml).La MRI ho mostrato una severa riduzione del volume pancreatico residuo (più basso nelle PG rispetto alle PJ 26±3.1 vs 36±4.1 ml), e un netto aumento di diametro del dotto pancreatico residuo dopo PG (4.6±0.92 vs PJ 2.4±0.18 mm), indice di pancreatite ostruttiva. Conclusioni. Dopo interventi di DCP una marcata riduzione sia del volume pancreatico residuo sia della capacità funzionale del pancreas rappresentano la regola, e portano quasi invariabilmente all’insorgenza di steatorrea; la qualità di vita, nel lungo termine, risulta pari a quella dei controlli; i sintomi digestivi suggestivi di malassorbimento o malnutrizione non differiscono da quanto osservato in una popolazione ambulatoriale “normale”; si osserva invece frequentemente un deficit importante di micronutrienti, quale la vitamina D; risulta importante la necessità di una terapia enzimatica sostitutiva in tutti i pazienti, indipendentemente dal corredo sintomatologico presentato.
Introduction. The anastomosis of the residual pancreas with digestive tract after pancreaticoduodenectomy (PD) is a critical aspect in the management of the surgical patient that can affect many variables ranging from the quality of life to the development of exocrine pancreatic insufficiency. The standard technique of pancreo-jejunal-anastomosis (PJ) is often replaced by pancreo-gastro-anastomosis (PG), more easy to perform and with fewer complications. There is no long-term study of comparison between the two types of anastomosis. Material and Methods. We evaluated 31 patients after duodeno-cefalo-pancreatectomy (DCP) for pancreatic tumor from 2001 to 2006. All were hospitalized and submitted to morphological and functional studies. We studied the pancreatic volume and the diameter of the main pancreatic duct (MRI), the exocrine function of the pancreas (fecal fat, fecal-elastase and vitamin D) and endocrine function. The quality of life was assessed using the EORTC QLQ-C30. It was reported the mean ± 1 standard error. The normality of the distribution was investigated by the Kolmogorov-Smirnov test and the correlation between independent variables by the Bravais-Pearson test. Results. We studied 31 patients (15 with PG and 16 PJ). No difference was found in the duration of follow-up, BMI, endocrine function, symptom scores and quality of life. The exocrine pancreatic function is worse after PG than after PJ (steatorrhea 26.6 ± 4.1 vs 18.2 ± 3.6 g/day; FE-1 170.2 ± 25.5 vs 121.4 ± 6.7 µg/g). There is a reduction of vitamin D (higher in PG compared to PJ) (18.1 ± 1.8 vs 23.2 ± 3.1 ng / ml). The MRI showed a severe reduction in the residual pancreatic volume (lower in PG than PJ: 26±3.1 vs 36±4.1 ml), and an increase in the diameter of the pancreatic duct after PG (4.6 ± 0.92 vs 2.4 ± PJ of 0.18 mm), indicative of obstructive pancreatitis. Conclusion. After DCP there is a marked reduction both of the residual pancreatic volume both of the functional capacity of the pancreas which lead to steatorrhea. In the long term no differences in quality of life was found between operated patients and controls. Digestive symptoms suggestive of malabsorption or malnutrition not differ from that observed in a "normal" population-patient. However there is frequently a lack of important micronutrients, such as vitamin D and all patients needed important enzyme replacement, regardless of the set of symptoms presented