Abstract
Laboratory testing of serum amylase and/or lipase levels are central to the diagnosis of acute pancreatitis (AP) as these tests are quick, cheap, reliable and perhaps the only objective criteria available at the bedside at the time of initial presentation. It is important to understand the physiology and biochemistry of these tests in order to get a clear grasp of their diagnostic utility. Lipase is more specific than amylase and stays elevated longer than amylase due to its longer half-life in serum resulting from renal tubular reabsorbtion. There is no advantage of testing both lipase and amylase, as well as no advantage in serially trending them for monitoring the clinical progress of the patient. They have no role in determining the etiology or severity of acute pancreatitis. The American College of Gastroenterology (ACG) guidelines for the diagnosis and management of acute pancreatitis recommend using 3 times the upper limit of normal (ULN) as the cut off for diagnosis. These cut off levels appear to be quite arbitrary. If the clinical suspicion for acute pancreatitis is high, imaging studies should be performed to confirm or rule out the diagnosis of acute pancreatitis even with low elevation or no elevation of these enzymes. This article is a comprehensive review of the existing literature on serum lipase and amylase as diagnostic tools for AP and their cut off levels used for the diagnosis of AP.
Highlights
Acute pancreatitis (AP) is a very common GI disorder
The American College of Gastroenterology (ACG) practice guidelines for the diagnosis and management of acute pancreatitis (AP) recommend that the diagnosis of AP be established by the presence of 2 of the following 3 criteria: 1) Abdominal pain consistent with AP 2) serum lipase and/or amylase greater than 3 times the upper limit of normal (ULN) 3) characteristic findings from abdominal imaging (Contrast Enhanced CT or MRI) [4]
The current ACG practice guidelines for the diagnosis and management of AP recommend that in patient presenting with abdominal pain consistent with AP, a serum lipase and/or amylase level greater than 3 times ULN is diagnostic of AP [4]
Summary
Acute pancreatitis (AP) is a very common GI disorder. With increasing number of hospital admissions [1] for AP, the financial impact of this disease is huge [2]. In the year 2009, the total discharges with the principal diagnosis of acute pancreatitis in the United States were 274,119 This marked a 30% increase from the year 2000. CECT is recommended when the diagnosis of AP is in doubt or if the patient fails to improve/worsens clinically after 48 hours of admission. This is due to the cost involved and the lack of sensitivity of CT early in the course of the disease. The only objective diagnostic criteria routinely available at the time of initial patient contact are serum levels of pancreatic enzymes lipase and/or amylase. Jasdanwala S (2015) A critical evaluation of serum lipase and amylase as diagnostic tests for acute pancreatitis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
