Abstract
Amylase is elevated in the foregut and has been used to confirm anastomotic integrity after pancreatic surgery. The physiological activity of pancreatic enzymes in the ileum has been studied in healthy volunteers but not quantitated with the simple and readily available amylase measurements employed with serum tests. We aim to quantitate the levels of amylase in the terminal ileum. This was a prospective, non-randomised, non-blinded, consecutive cohort study conducted at the Royal Brisbane and Women’s Hospital. Consecutive patients undergoing routine surgery with an ileostomy were invited to participate in the study. Ileostomy effluent was collected and analysed daily for the first 5 post-operative days. This validation cohort included 8 males and 3 females, with a mean age of 49 years. Median daily amylase levels ranged from 4470 U/L to 23,000 U/L, with no specimens falling within the laboratory serum reference range of 40 to 130 U/L. Two specimens were not available on day one post-operative due to complete ileus. The sample size of 11 patients is small but was considered sufficient given that 55 effluent specimens were anticipated for analysis. Amylase levels remain highly elevated as the enzyme transits through the length of the small intestine and measured in the terminal ileum, and can be readily quantitated by the existing testing methodology routinely available.
Highlights
Amylase is elevated in the foregut and has been used to confirm anastomotic integrity after pancreatic surgery
Serum amylase levels are measured for the diagnosis of pancreatitis with a level of 2–4 times the upper limit of normal being considered diagnostic of acute pancreatitis
We describe the amylase levels in the terminal ileum in relation to normal serum levels
Summary
Amylase is elevated in the foregut and has been used to confirm anastomotic integrity after pancreatic surgery. The physiological activity of pancreatic enzymes in the ileum has been studied in healthy volunteers but not quantitated with the simple and readily available amylase measurements employed with serum tests. Amylase levels remain highly elevated as the enzyme transits through the length of the small intestine and measured in the terminal ileum, and can be readily quantitated by the existing testing methodology routinely available. The functional activity of amylase in the gut has been studied by Holtmann et al.[4] They found that the activity of pancreatic enzymes declined during aboral intestinal transit. In 2005, The international study group on pancreatic fistula defined amylase levels of 3 times the serum levels on day 3. Other studies have used serum levels of greater than 1000 U/L on day one, post operative as a diagnostic criterion[3]
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