Elastase Test (Pancreatic)

What is Elastase?

Elastase (also called elastase-1, pancreatic elastase, faecal elastase, or ELA1) is a digestive enzyme. It is made by the pancreas, a gland in the upper abdomen, that plays an important role in the digestion, absorption, and metabolism of food.

Specifically, elastase is a protease enzyme that mainly breaks down elastin. Elastin is the elastic protein found in structural protein fibres in the tissues, which provides elasticity and strength to tissues such as lungs, skin, and blood vessels. During digestion, elastase breaks down dietary proteins, enabling their absorption for tissue growth, maintenance, and repair. Elastase also contributes to the remodelling of proteins in the fluid surrounding cells by removing old and depositing new elastin fibres, thus assisting in tissue repair and regeneration.

In healthy people, elastase is secreted by the pancreas into the pancreatic duct linked to the small intestine. It is not broken down as it passes through the intestine and so can be found in the stool (faeces or poo), where it accumulates.

What is an Elastase test?

The elastase test, also called the faecal elastase test-1, measures the elastase concentration in a stool.

Elastase remains very stable during its passage through the intestine and so can be measured in a stool sample. Its concentration in the stool is five times higher than that in pancreatic enzyme secretion. Additionally, the elastase concentration in stool correlates well with pancreatic enzyme secretion, making it a good biomarker for pancreatic function.

The elastase test has the advantages of not requiring a stool collection over a specified time or a special diet.

Why is an Elastase test important?

Measuring elastase levels in stool can help to diagnose exocrine pancreatic insufficiency (EPI). This is a condition where the pancreas does not produce enough digestive enzymes, including those that digest fats (lipases), proteins (proteases, including elastase), and carbohydrates (amylases), or where the activity of those enzymes is too low to enable the normal digestion of nutrients.

EPI may be due to:

• Insufficient stimulation of the pancreatic acinar cells that make and secrete the digestive enzymes.
• A reduced amount of secretion from the acinar cells.
• A blockage of the pancreatic duct that interferes with the flow of secretion from the pancreas to the duodenum.
• Incomplete mixing of the pancreatic enzymes with food in the duodenum.

The condition means that the body cannot absorb all the food’s nutrients, which can lead to malnutrition. In turn, malnutrition can lead to increased morbidity, reduced quality of life, and serious health problems.

EPI is caused by damage to the pancreas or blockage of the pancreatic duct.

• The main health disorder causing damage/blockage in adults is chronic pancreatitis and in children is cystic fibrosis.
• Other disorders include acute pancreatitis, pancreatic cancer, diabetes, gastrointestinal disorders (inflammatory bowel disease, irritable bowel syndrome, untreated celiac disease), surgery of the pancreas or upper gastrointestinal tract, and genetic disorders (e.g., Shwachman-Diamond syndrome in children).

Who should have their Elastase level tested?

An elastase test should be considered by anyone with:

• Oily, foul-smelling stools (steatorrhea); these are the most distinctive feature, occurring when the intestine cannot absorb dietary fats.
• Digestive symptoms of EPI, including bloating, abdominal discomfort or pain, flatulence (passing excess gas), and greasy foul-smelling stools.
• Other signs and symptoms, including unintentional weight loss, poor weight gain, delayed growth in children, low body stores of fat-soluble vitamins (vitamins A, D, E, and K), and malnutrition.
• A pancreatic disorder causing EPI, particularly chronic pancreatitis in adults and cystic fibrosis in children, but also including acute pancreatitis, pancreatic cancer, pancreatic benign tumours, after pancreatic surgery, and/or a genetic disorder affecting the pancreas (e.g., Shwachman-Diamond syndrome in children).
• A non-pancreatic disorder causing EPI, including type I and II diabetes, gastrointestinal disorders (ulcerative colitis, Crohn’s disease, irritable bowel syndrome, untreated celiac disease), following surgery of the gastrointestinal tract, and/or a genetic disorder affecting the pancreas (e.g., Shwachman-Diamond syndrome in children).
• A history of drinking alcohol and/or smoking, because alcohol is the main causal factor for chronic pancreatitis; both alcohol and smoking are dose-dependently associated with pancreatic damage and cases of recurrent acute pancreatitis and chronic pancreatitis; and because together they worsen each other’s harmful effect.

The elastase test is used for diagnosis of EPI and not to monitor treatment in individuals with EPI receiving Pancreatic Enzyme Replacement Therapy (PERT).

How to test for Elastase?

The elastase test requires a small sample of stool that you collect in the privacy of your home. The test kit is equipped with everything needed for collection of a sample together with instructions on how to collect the sample.

Briefly, after reading the instructions, complete the labels and stick them on the collection tube. Then, to collect a stool sample, put toilet paper in the toilet bowl, and pass a stool onto the toilet paper. Ensure the stool does not get wet with toilet water. Using the sampling stick (attached to the collection tube lid), scrape the stool until the stick is evenly covered with stool. Put the sampling stick back in the collection tube, and close the tube lid. Pack the tube in the test-kit box, as instructed, and post immediately for laboratory analysis.

The elastase concentration is measured in the stool. The stool sample must be taken from a formed stool. Watery stools can give misleading results, as they usually result in low elastase concentrations.

How long do Elastase results take?

The testing process for Elastase is 5 days from the point the sample is booked in at the laboratory.

What are normal Elastase test results?

There is general agreement that the lower the faecal elastase concentration, the greater the chances of EPI. An elastase test result of greater than 200 µg/g faeces is usually accepted as the threshold for pancreatic sufficiency, i.e., that there is no reduction in pancreatic enzyme activity below that required for normal digestion.

An elastase test result of:

• less than 100 µg/g is specific for severe EPI.
• 100–200 µg/g is indicative of mild to moderate EPI.
• less than 200 µg/g is considered to be abnormal; EPI is typically diagnosed.
• 200–500 µg/g may be difficult to interpret; some individuals may benefit from treatment (PERT) and require further testing.
• above 500 µg/g is often typical for normal pancreatic exocrine function.

At the 200 µg/g threshold, the test for EPI is of high sensitivity and moderate specificity. However, the test can give a false-positive result where the person is at low risk of EPI and a false-negative result in those at high risk. While the test is sensitive and specific for detecting EPI in severe cases and high-risk individuals, it can be less reliable in mild cases, low-risk individuals, after pancreatic resection or in loose watery stools.

Further investigations will probably be required for people with a normal elastase test result but with symptoms (to determine the cause of the symptoms) and for those with abnormally low elastase test results (to confirm EPI).

How to maintain normal Elastase levels

EPI symptoms may improve from eating small but frequent healthy meals.

Complete cessation of alcohol consumption and smoking is recommended because they not only cause EPI, they exacerbate existing chronic pancreatitis and are a risk factor for pancreatic cancer (adenocarcinoma). Alcohol can also decrease lipase activity and negatively affect the success of PERT.

EPI is usually a life-long condition because it occurs following permanent damage to the pancreas. Treatment to replace the missing pancreatic enzymes (PERT) is therefore for the long term. Take all your medicines as prescribed, which may include vitamins and other supplements.

References

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de la Iglesia D, Agudo-Castillo B, Galego-Fernández M, et al. Diagnostic Accuracy of Fecal Elastase-1 Test for Pancreatic Exocrine Insufficiency: A Systematic Review and Meta-Analysis. United European Gastroenterol J. 2025;13:1571-1582.

Dominguez-Muñoz JE, Vujasinovic M, de la Iglesia D, et al; European PEI Multidisciplinary Group. European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations. United European Gastroenterol J. 2025;13:125-172.

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PHARMIWEB.COM. the vital and complex role of elastase. 25 Sep 2024. Available from: https://www.pharmiweb.com/article/the-vital-and-complex-role-of-elastase Accessed 26 May 2026

Szentesi A, Farkas N, Sipos Z, et al; Hungarian Pancreatic Study Group. Alcohol consumption and smoking dose-dependently and synergistically worsen local pancreas damage. Gut. 2022;71:2601-2602.

Tian C, Ghodeif AO, Arshad S, et al. Exocrine Pancreatic Insufficiency. [Updated 2025 Sep 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555926/.

University Hospitals Sussex Pathology. Royal Sussex County Hospital. Princess Royal Hospital. DHEAS. Last updated 24 May 2023. Available from: https://pathology.uhsussex.nhs.uk/pug/?view=article&id=338:elastase-faeces&catid=10. Accessed 26 Apr 2024.