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Pancreatic Insufficiency

Question
Hello,

My 14 months old CF daughter was diagnosed one month after her birth: DF508
and G3272-26A mutations.

After her birth, she was 237 for fecal elastase, which means she was "pancreatic sufficient." In her annual report last month (14 months old), the fecal elastase showed a rate of 167. She is very well, her stools are normal and she measures 77cm with 11kg, so she has a very good evolution.

My question is: I read on different sites that a normal elastase exceeds 200 and on other that it's 150. What is "standard"?

Does the drop of fecal elastase mean that she should expect to become pancreatic insufficient?

The ultrasound showed that her pancreas was "fibrous": are there consequences on pancreatic insufficiency?

For now, our CF center has not prescribed pancreatic enzymes since there is no sign of pancreatic insufficiency. We monitor and will control elastase during the year.

About respiratory symptoms: she has a score of 24/25, what does this score mean? Secretions were visible in her right lung, with daily sessions of physiotherapy she has from birth on. Can this go away? Is it serious ?

She's colonized with staph aureus but asymptomatic since birth.

Thank you for your valuable answers,
Thank you again.
A.
Answer
Hello,

Fecal elastase is a pancreatic enzyme which is determined on a single stool sample. Fecal elastase > 200μg / g stool indicates a normal pancreatic function, while a value of less than 100μg / g shows an exocrine pancreatic insufficiency. Fecal elastase is a good and sensitive examination in the absence of diarrhea that can distort the result.

A result of 167 µg/g is intermediate; it does not mean that your child will become pancreatic insufficient, but the fecal elastase assay will indeed have to be rechecked.

The mutation 3272-26A> G is known to be frequently associated with pancreatic sufficiency.

Regarding the pulmonary aspect, it is difficult to answer with these few elements.

Feel free to ask the doctor in tour CF center to discuss with you on pulmonary status of your daughter, in a more comprehensively way.

Cordially
Dr Michèle Gérardin
24.11.2015