Pancreatic Elastase 1

Optimal Result: 200 - 1000 mcg/g.

The pancreatic elastase 1 fecal test is used to diagnose insufficiencies of the pancreas that result in diseases such as:

- Cystic fibrosis

- Chronic pancreatitis

- Pancreatic cancer

- Inflammatory Bowel Disease

- Gallstones

- Diabetes, Type 1

- Shwachman-Diamond Syndrome

In many of these conditions, there is often diarrhea, weight loss, undigested food in the stool, and pain in the abdomen. If the condition continues for a longer period of time, then low bone density may be found.

This test is an excellent biomarker for how well the pancreas is working because the enzyme pancreatic elastase I is not broken down by what happens in the intestinal tract. The Elastase I protein is found concentrated in the stool, five times higher than what is found in pancreatic juice. 

Normal Ranges for Pancreatic Elastase in ug/gram fecal matter:

Normal: >200 ug elastase/gram fecal matter

Severe pancreatic insufficiency: <100 ug elastase/gram fecal matter

Moderate pancreatic insufficiency: 100-200 ug elastase/gram fecal matter


- Lam KW, Leeds J. How to manage: patient with a low faecal elastase. Frontline Gastroenterol. 2019 Nov 15;12(1):67-73. doi: 10.1136/flgastro-2018-101171. PMID: 33489070; PMCID: PMC7802491. [L]

What does it mean if your Pancreatic Elastase 1 result is too high?

There are no problems recorded in medical literature for high levels of Pancreatic Elastase I. 

What does it mean if your Pancreatic Elastase 1 result is too low?

The lower the level of Pancreatic Elastase I is in the stool, the worse the pancreatic insufficiency is. 

Doctors find that the following conditions are associated with low levels of pancreatic elastase I:

- Cystic fibrosis

- Chronic pancreatitis

- Pancreatic cancer

- Inflammatory Bowel Disease

- Gallstones

- Diabetes, Type 1

- Shwachman-Diamond Syndrome


If used routinely in gastrointestinal practice, an abnormal result will frequently occur but this cannot be assumed to mean that the person has PEI. This finding should prompt the clinician to arrange further investigations to identify whether there is evidence of primary PEI, secondary PEI or whether there is another reason why the Fel-1 level is low.

A low Pancreatic Elastase 1 may indicate that the cause of symptoms may be due to a pancreatic cause and should prompt further investigations to identify this rather than only treat with PERT.

Making a diagnosis of PEI requires more than a single abnormal Fel-1 level and includes assessment of the patients’ symptoms, nutritional status, risk factors for pancreatic disease, endocrine function and structural imaging. Early diagnosis is important as treatment with PERT alleviates symptoms, improves quality of life and helps prevent long-term complications related to fat malabsorption.


How to increase Pancreatic Elastase?

If you are diagnosed with chronic pancreatitis, there are treatments that can help manage your condition. Treatment usually includes dietary changes, medicines to manage pain, and/or pancreatic enzyme supplements you can take with each meal. Your provider may also recommend that you give up drinking alcohol and smoking.

Pancreatic Exocrine Insufficiency Management

It is important to treat the underlying cause of PEI, and these treatments will vary depending on the cause. However, there are options available that make it easier for the body to break down and absorb nutrients, which can help reduce the steatorrhea and nutritional deficiencies that PEI causes.

Lifestyle Changes

Eat multiple, small meals spaced throughout the day, rather than one or two large meals. It is easier for your small intestine to absorb nutrients when there isn’t as much food to digest at once. Fatty foods can worsen steatorrhea, but it is still important to consume enough fat for necessary bodily functions and because fats are required to absorb certain vitamins. Just ensure that it is primarily from either plant sources – such as nuts, seeds, or olives – or from fatty fish, rather than from processed foods or red meat. And while fibre is good for gut health, for many individuals with PEI it is better to keep fibre intake low, as this can make digestion easier. Underweight individuals will need to focus on high-calorie foods, to get enough energy for optimal health. If you have PEI, it is a good idea to consult with a registered dietitian, who can work with you to establish a meal plan tailored to your lifestyle, that maximizes the nutritional quality of what you eat, and reverses any nutritional deficiencies.

Blood tests allow your physician to analyze levels of different micronutrients in your blood and then recommend supplements to help bring these levels back to normal.

Avoid drinking alcohol and smoking cigarettes, as these products can be damaging to the pancreas, especially in those who have PEI from chronic pancreatitis or pancreatic cancer.

Enzyme Therapy

The most effective treatment for PEI is pancreatic enzyme replacement therapy (PERT), which involves taking a medication called pancrelipase to provide the body with enzymes that break down fats and proteins. Those with PEI must take PERT with each meal or snack that contains fat and/or protein. When you consume PERT with food, it duplicates the normal digestive process because the enzymes mix with the food and help you absorb more nutrition from the food and supplements that you consume.

You will need to work with your healthcare team to establish dosage for PERT. The amount of enzymes needed varies from person-to-person and meal-to-meal, with large, fatty meals requiring more enzymes than small, low-fat meals. PERT is a safe treatment, without any known serious side effects.

Pancreatic Exocrine Insufficiency Outlook

With pancreatic enzyme replacement therapy and some changes to dietary adjustments, you can manage symptoms of pancreatic exocrine insufficiency. However, it is most important to work with your healthcare team to treat the underlying cause of PEI.

Frequently asked questions

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