Journal article
Diagnostic Performance of Fecal Elastase and Risk Factors for Exocrine Pancreatic Insufficiency in Children with Pancreatitis: An INSPPIRE-2 Study
The Journal of pediatrics, Vol.298, 115245
07/18/2026
DOI: 10.1016/j.jpeds.2026.115245
PMID: 42471081
Abstract
To evaluate the diagnostic performance of fecal elastase (FE) in exocrine pancreatic insufficiency (EPI) and examine the risk factors for EPI in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP).
We analyzed prospectively collected demographic, clinical, and EPI data of children with ARP or CP (n=1007) enrolled in the INSPPIRE-2 (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) consortium. FE performance was assessed against individual markers of fat malabsorption and a composite reference standard in which the presence of any 1 of the following was considered consistent with fat malabsorption in lieu of a gold-standard pancreas function test: (1) clinical diagnosis of EPI, (2) vitamin A or E deficiency, or (3) BMI z-score ≤–2. Cox regression models were used to identify predictors of EPI.
EPI was diagnosed in 195/1007 (19.4%) children with ARP/CP, with FE being the most commonly used diagnostic tool. FE demonstrated low sensitivity (55.8% and 65.1%), moderate specificity (82.8% and 75.5%), and a high negative predictive value (92% and 93%), at cut-offs of 100 μg/g and 200 μg/g stool, respectively, in detecting at least 1 marker of fat malabsorption. The 7-year cumulative incidence of EPI after the first pancreatitis episode was 24%. Genetic risk factors were associated with earlier progression to EPI (HR 1.56; 95% CI 1.02–2.39).
EPI affects nearly 20% of children with ARP/CP. FE is a valuable diagnostic tool in ruling out EPI. Children with genetic risk factors need closer surveillance due to an increased risk for developing EPI.
Details
- Title: Subtitle
- Diagnostic Performance of Fecal Elastase and Risk Factors for Exocrine Pancreatic Insufficiency in Children with Pancreatitis: An INSPPIRE-2 Study
- Creators
- Vybhav Venkatesh Gummadi - University of TorontoTanja Gonska - SickKids FoundationVeronique D. Morinville - Montreal Children's HospitalAsim Maqbool - Children's Hospital of PhiladelphiaFuchenchu Wang - The University of Texas MD Anderson Cancer CenterGretchen A. Cress - University of IowaMaisam Abu-El-Haija - Cincinnati Children's Hospital Medical CenterReuven Zev Cohen - Emory UniversityElissa M. Downs - University of Minnesota Children's HospitalDouglas S. Fishman - Baylor College of MedicineA. Jay Freeman - Nationwide Children's HospitalMatthew J. Giefer - Ochsner Medical CenterGila Ginzburg - Children's Hospital of WisconsinAmit S. Grover - Boston Children's HospitalAndrew Y.J. Liman - Stanford UniversityDouglas Lindblad - Children's Hospital of PittsburghQuin Y. Liu - Cedars-Sinai Medical CenterJacob A. Mark - Children's Hospital ColoradoBrian A. McFerron - Riley Hospital for ChildrenMegha S. Mehta - The University of Texas Southwestern Medical CenterKenneth Ng - Johns Hopkins UniversityRobert Adam Noel - Baylor College of MedicineChee Y. Ooi - Sydney Children's HospitalEmily R. Perito - University of California, San FranciscoMichael Wilschanski - Hadassah Hebrew University Hospital, Jerusalem, IsraelYuhua Zheng - Children's Hospital of Los AngelesSuyu Liu - The University of Texas MD Anderson Cancer CenterMark Lowe - Washington University in St. LouisAliye Uc - University of IowaChronic Pancreatitis Clinical Research Consortium (formerly CPDPC)
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.298, 115245
- DOI
- 10.1016/j.jpeds.2026.115245
- PMID
- 42471081
- NLM abbreviation
- J Pediatr
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Publisher
- Elsevier Inc
- Grant note
- National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health: U01DK108334, U01DK108328
A. J. F. is a consultant for Triveni, BridgeBio. and Alcresta; receives grant funding from Anagram; is a CAPER board member. M.E.L. is a consultant for the CF Foundation. Y.Z. is a consultant for Triveni. E.M.D. receives research funding from Anagram and CFF; E.R.P. is a consultant for BridgeBio, receives grant funding from Mirum, Albireo, and Gilead. M.W. received research funding from Vertex pharmaceuticals and is a consultant to Synspira Pharm. The other authors declare no conflicts of interest.Research reported in this publication was supported by National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award numbers U01DK108334, U01DK108328 related to The Chronic Pancreatitis Clinical Research Consortium (CPCRC).The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Language
- English
- Electronic publication date
- 07/18/2026
- Academic Unit
- Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
- Record Identifier
- 9985213680502771
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