Pancreatic Insufficiency as Cause of Malabsorption in Elderly
In a recent study, fecal pancreatic elastase-1 levels in older individuals are seen to be on the higher side, although they had no gastrointestinal diseases or diabetes mellitus.
As we agestructural changes in pancreas takes place and the incidence of maldigestion and malnutrition goes up . This happens because of inadequate pancreatic enzyme secretion due to degenerative processes and damage of the gland as a natural ageing process. An enzyme called - Fecal pancreatic elastase-1 (PE) has been found to be a noninvasive fecal marker for assessing the pancreatic function and can be an useful test in the elderly to see understand .if they are suffering from pancreatic insufficiency.
Dr. Karl-Heinz Herzig, Professor at Department of Biotechnology and Molecular Medicine, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland who was the lead investigator of the study said that, "The purpose of this study was to investigate the fecal elastase-1 levels among older (over 60 years) Polish and Finnish healthy individuals without any special diet, had no known gastrointestinal disease, surgery, or diabetes mellitus."
About the Study -A total of 159 patients were enrolled in this cross-sectional study. A total of 106 older individuals (aged 60-92 years) were recruited from nearby outpatient clinics and old age homes. They were divided into three age groups: 60-69 years old (31); 70-79 years old (n 38) and over 80 years old (37). Fifty three young individuals (between 20-28 years old) were investigated as "controls". Inclusion criteria for the study were age over 60 years, normal status and competence. Exclusion criteria were special diet, any known gastrointestinal disease or prior gastrointestinal surgery, and diabetes mellitus. Fecal elastase-1 level was measured from stool samples with an ELISA method.
Results - It was noticed that fecal elastase-1 levels correlated negatively with age and were significantly lower among individuals who were over 70 years old as compared to the controls). Fecal elastase-1 concentrations were below the cut off level of 200 μg/g in 23 of 106 individuals among the over 60 year's old subjects, which is indicative of pancreatic exocrine insufficiency. Out of these, nine subjects had fecal elastase-1 level below 100μg/g which strongly recommends severe pancreatic insufficiency.
Conclusion - Dr. Herzig concludes it by saying, "Our study shows that one fifth of healthy elderly individuals without any gastrointestinal disorder, surgery or diabetes mellitus suffer from pancreatic exocrine insufficiency and might get benefited from enzyme supplementation therapy."
He further added, "In the general unselected group of people with a high incidence of mal-absorption syndromes, diabetes mellitus, and abdominal surgery, the incidence might be even higher. It is important to generate a better awareness of these problems in the unscreened population, since for these patients, careful clinical examination and possibly pancreatic enzyme replacement therapy is needed."
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