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Comparison of Diagnostic Methods for Pancreatic Insufficiency in Infants With Cystic Fibrosis

Tardelli, Amanda C.S.*; Camargos, Paulo A.M.; Penna, Francisco J.; Sarkis, Pauliane F.B.§; Guimarães, Elizabet V.

Journal of Pediatric Gastroenterology and Nutrition: February 2013 - Volume 56 - Issue 2 - p 178–181
doi: 10.1097/MPG.0b013e31826f2b71
Original Articles: Gastroenterology

Objective: The objective of the present study is to compare daily weight gain and laboratory analysis (72-hour fecal fat and steatocrit) with fecal elastase-1 (EL-1) when diagnosing pancreatic insufficiency (PI) in infants with cystic fibrosis (CF).

Methods: A total of 39 infants with CF, diagnosed consecutively by newborn screening at 2 referral centers, were included in the study. Daily weight gain and results of laboratory analysis of stool samples were compared using the κ coefficient and the receiver operator characteristic (ROC) curve.

Results: Using the criterion of low daily weight gain, the frequency of PI was 92.3%; using the 72-hour fecal fat, steatocrit, and fecal EL-1 tests, the frequency was 42.3%, 86.2%, and 84.6%, respectively. EL-1 was used as the reference test. It was observed that the criteria of low daily weight gain (<50th percentile) and abnormal steatocrit, used together, showed the highest sensitivity (91.3%) and specificity (83.3%) for the diagnosis of PI.

Conclusions: When fecal EL-1 analysis is not immediately available, low daily weight gain associated with abnormal steatocrit can be adopted as a criterion for initiating pancreatic enzyme replacement therapy in infants with CF; however, EL-1 testing should be performed later for confirmation of PI.

*University Hospital/Federal University of Minas Gerais, Belo Horizonte

Health Sciences Center, Federal University of Saõ João del-Rei, Divinópolis

Department of Pediatrics, Diagnostic Support Action and Research Center (NUPAD)/Medical School, Pediatric Gastroenterology Center/University Hospital–Federal University of Minas Gerais

§University Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Address correspondence and reprint requests to Elizabet V Guimarães, MD, PhD, Associate Professor, Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (e-mail:

Received 26 October, 2011

Accepted 9 August, 2012

P.C. is supported by the Brazilian research agencies CNPq-Brazilian Council for Scientific and Technological Development (Grant #303827/2009-2) and FAPEMIG—Minas Gerais State Foundation for Research Support (Grant #PPM-00230-10).

The authors report no conflict of interest.

Copyright 2013 by ESPGHAN and NASPGHAN