A 48-year-old man with a history of recurrent alcohol-related pancreatitis now reports bulky, greasy stools and weight loss. Which test is MOST appropriate to document pancreatic exocrine insufficiency?

• A Serum amylase
• B Serum trypsinogen
• C Secretin stimulation test with duodenal aspiration
• D Fecal elastase-1 concentration ✓

Explanation

Fecal elastase-1 is a simple, noninvasive screening test for exocrine pancreatic insufficiency; elastase passes through the gut undegraded, so its fecal concentration directly reflects pancreatic secretory output and falls in moderate to severe insufficiency. Serum amylase and lipase are usually normal in chronic pancreatitis because residual function suffices to keep them in range. The secretin stimulation test is the gold standard but is invasive and reserved for cases where noninvasive tests are inconclusive.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.