Faecal pancreatic elastase--1 a non invasive measure of exocrine pancreatic function

BACKGROUND

Faecal pancreatic elastase-1 is a laboratory based test used for the diagnosis or exclusion of exocrine pancreatic insufficiencies. Pancreatic elastase-1, is released into blood circulation during inflammation of the pancreas, but unlike most pancreatic enzymes it is stable during intestinal passage and not degraded.

OBJECTIVES

The major objective of this work was to establish the assay of faecal pancreatic elastase-1 in spot stool samples as an exocrine pancreatic function test at Korle-Bu (a referral) hospital in Ghana, for the diagnosis of pancreatic diseases.

METHOD

Twenty-five apparently healthy persons; mean age of 43.4 years and thirty-two patients with various pancreatic diseases, mean age 51.4 years were referred for the test based on clinical presentation, imaging studies and biopsy findings. The male to female ratio was 6.4:3.6 and 8.1:1.9 respectively. An ELISA technique which recognizes human pancreatic elastase-1 from spot stool samples was employed for the test and read photometrically at 405nm.

RESULTS

Elastase-1 activity in spot stool samples from apparently healthy group ranged from 165 to 870mg/g with a mean of 379 (SE 41)mg/g, and a range of 20 to 285mg/g with a mean of 112.9 (SE 11.6)mg/g obtained for the pancreatic disease group. Disease severity was classified as mild to moderate with elastase-1 concentration between 100 and 200mg/g stool and the severe pancreatic insufficiency group with elastase-1 concentration of less than 100mg/g stool. The pancreatic elastase-1 was found to be stable in faeces for several weeks when stored frozen, hence the convenience for batch determinations.

CONCLUSION

The test is non invasive and can assist with the diagnosis of inflammatory conditions of the pancreas where imaging results are equivocal.

Homogeneous immunoglobulins in Ghanaians living in Accra, Ghana

Serum screening for homogeneous immunoglobulins (H-Ig) was done on 149 apparently healthy Ghanaians (aged 17-95 years) and 73 sick subjects who presented at the Korle-Bu Teaching Hospital from October 1999 to September 2000. Sera were screened by agarose gel electrophoresis and those with equivocal results were confirmed by immunoelectrophoresis. Immunoglobulin classes (IgG, IgA and IgM) and Bence Jones proteinuria were measured and determined by single radial immunodiffusion method and heating respectively. Total protein, albumin, calcium, uric acid, urea and creatinine were estimated on ACE chemistry autoanalyser. The laboratory profile of 5 Ghanaians with a picture of multiple myeloma and one with monoclonal gammopathy of undetermined significance drawn from the sick subjects (6 of 73) are presented. None of the 149 healthy subjects studied in three age groups (17-40; 41-64 and dollar 65 years) had H-Ig, and their serum IgG, IgA, IgM, urea, creatinine, uric acid, calcium, total protein and albumin levels were within the normal range. H-Ig were present in sera of 6 out of the 73 sick subjects (8.2%); 5 of them (4 males, 1 female) presented a picture of multiple myeloma. Three of these 5 patients had IgG, and the others IgA paraproteinaemia. All 5 patients had immunoparesis which was absent in the 6th patient (a male) who also had IgA paraproteinaemia (< 10 g/L), active bone marrow with < 2% mature plasma cells and no renal involvement. Results of bone marrow examination supported a diagnosis of multiple myeloma in the 3 patients with IgG paraproteinaemia, but were not available for the other two. Bence-Jones proteinuria was found in 2 (both with IgG paraproteinaemia) of 4 patients (50%) available for testing. Renal involvement was indicated in the 5 patients with a picture of multiple myeloma as urea and creatinine levels were significantly raised.