Fecal pancreatic elastase in dogs and cats

What it shows

EPI develops when the enzyme-producing (acinar) tissue of the pancreas can no longer make and release enough digestive enzymes — only after about 90% or more of it is lost. Less enzyme then reaches the gut, and fecal elastase falls. The canine fecal elastase assay is an ELISA validated for dogs.

It is mainly an alternative for places where the blood test is not available. Serum trypsin-like immunoreactivity (TLI) is the gold-standard test for EPI in dogs and cats, and given how well it performs, other tests are rarely needed.

The weak point of fecal elastase is false positives. It has been described as highly sensitive but with low specificity: some healthy dogs and dogs with chronic small-intestinal disease have a severely decreased fecal elastase. In one study, of 26 dogs with fecal elastase below 10 µg/g, 6 (23%) had serum TLI within or above the reference range. The authors concluded that a diagnosis of EPI must be confirmed by other means.

Higher than reference — what it may be a sign of

For this test a high value is not a finding in itself — what the test looks for is a low result. A fecal elastase above 20 µg/g is described as helping to rule EPI out. If a dog has weight loss or loose stools and elastase is high, the vet looks for another explanation of the signs.

Lower than reference

• Exocrine pancreatic insufficiency — low concentrations of fecal elastase are consistent with EPI. A value below 10 µg/g is described as needing confirmation with canine TLI.
• A false low result — some healthy dogs and dogs with chronic small-intestinal disease have severely decreased fecal elastase without EPI. That is why the test is considered much less reliable than serum TLI, and a low result is a reason for the blood test rather than a diagnosis.

Look at together with

• TLI (cTLI, fTLI) — the blood test of choice for EPI; it confirms or rules out what a low elastase suggests. Its result is not affected by digestive enzymes given with food.
• Cobalamin (B12) and folate — measuring them together with TLI is strongly recommended: low cobalamin is common in dogs and cats with EPI.
• Pancreatic lipase (cPL, fPL) — the test for pancreatitis, a different question: inflammation, not lack of enzymes.

Units and conversion

Fecal elastase is reported in µg/g — micrograms of elastase per gram of feces. The result is a single number in one unit, so nothing needs converting; in the app the row keeps the value and unit printed on the form.

Reference range

The reference range is on your lab’s form. For this test the lower values matter: one clinical review gives working cut-offs for dogs — below 10 µg/g calls for confirmation with canine TLI, above 20 µg/g helps rule EPI out. These are interpretation thresholds for the canine assay; the laboratory’s own cut-offs are the ones that apply to the result. Even a clearly low value is read together with signs and confirmed by blood TLI before EPI is diagnosed.

Cats and dogs

Sources

1. Steiner JM. Exocrine Pancreatic Insufficiency in Dogs and Cats. Merck Veterinary Manual, professional version, full review September 2025.
2. Cridge H. Canine and Feline Exocrine Pancreatic Insufficiency. Today’s Veterinary Practice, July/August 2025.
3. Steiner JM, Rehfeld JF, Pantchev N. Evaluation of fecal elastase and serum cholecystokinin in dogs with a false positive fecal elastase test. J Vet Intern Med. 2010;24(3):643-646 (abstract).
4. Exocrine Pancreatic Insufficiency in Dogs. Clinician’s Brief, May 2011.
5. Texas A&M Gastrointestinal Laboratory — Serum Trypsin-Like Immunoreactivity (TLI).