Abstract
We studied the behavior of serum amylase and lipase in 66 consecutive patients with acute pancreatitis in order to assess the ability of these tests and of the serum lipase-amylase ratio to establish the etiology and predict the severity of acute pancreatitis. Forty-two patients had biliary acute pancreatitis, 14 had alcoholic acute pancreatitis, and the remaining 10 nonbiliary, nonalcoholic (NBNA) acute pancreatitis. Serum amylase and lipase were abnormally high in all patients. The elevations of both serum amylase and lipase were significantly lower in patients with alcoholic pancreatitis than in those with biliary pancreatitis, although a considerable overlap was observed between the two groups. No statistically significant differences were found between NBNA patients and those with either biliary or alcoholic forms of the disease. The serum lipase-amylase ratios in patients with alcoholic pancreatitis ranged from 0.2 to 5.6, in those with biliary pancreatitis from 0.1 to 7.9, and in those with NBNA pancreatitis from 0.1 to 4.4. These differences were not statistically significant. No differences in serum enzyme levels were observed among patients without apparent imaging signs of acute pancreatitis (N=20), those with signs of Pancreatic edema (N=36), and those with necrotizing pancreatitis (N=10). The results indicate that serum amylase and lipase concentrations are not able to establish either the etiology or to predict the severity of acute pancreatitis as assessed by imaging techniques. Furthermore, the serum lipase-amylase ratio is not useful in distinguishing acute episodes of alcoholic from nonalcoholic acute pancreatitis.
Similar content being viewed by others
References
Lifton LJ, Slickers KA, Pragay DA, Katz LA: Pancreatitis and lipase. A reevaluation with five-minute turbidimetric lipase determination. JAMA 29:47–50, 1974
Dubick MA, Mar G, Mayer AD, Majumdar APN, McMahon MJ, Geokas MC: Digestive enzymes and protease inhibitors in plasma from patients with acute pancreatitis. Pancreas 2:187–194, 1987
Hathaway JA, Kitt D, Wingate B: A comparison of a currently used serum lipase and amylase procedures in the serial detection of enzyme elevations in acute pancreatitis. Clin Chim Acta 133:327–330, 1983
Ventrucci M, Pezzilli R, Gullo L, Platè L, Sprovieri G, Barbara L: Role of serum pancreatic enzyme assays in diagnosis of pancreatic disease. Dig Dis Sci 34:39–45, 1989
Gumaste VV, Dave PB, Weissman D, Messer J: Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis. Gastroenterology 101:1361–1366, 1991
Tenner SM, Steinberg WM: Serum Lipase/amylase ratio in alcoholic vs nonalcoholic pancreatitis. Pancreas 6:722, 1991
Ventrucci M, Pezzilli R, Gullo L: Comparison of a new immunoassay for determining serum pancreatic isoamylase with two standard techniques. Am J Gastroenterol 85:1381–1385, 1990
Pezzilli R, Billi P, Fiocchi M, Ossani M, Sprovieri G, Fontana G: Serum lipase assay: a test of choice in acute pancreatitis. Panminerva Med 34:30–34, 1992
Nordestgaard AG, Wilson SE, Williams RA: Correlation of serum amylase levels with pancreatic pathology and pancreatic etiology. Pancreas 3:159–162, 1988
Gullo L, Priori P, Labò G: Natural history of acute pancreatitis and its relationship to chronic pancreatitis.In Acute Pancreatitis. Advances in Pathogenesis, Diagnosis and Treatment. PA Banks, G Bianchi Porro (eds). Milan, Masson Italia, 1984, pp 87–93
Strum WB, Spiro HM: Chronic pancreatitis. Ann Intern Med 74:264–277, 1971
Clark E: Pancreatitis in acute and chronic alcoholism. Am J Dig Dis 9:428–431, 1942
Renner IG, Savage WT, Pantoja J, Renner VJ: Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases. Dig Dis Sci 30:1005–1018, 1985
Hjelmqvist B, Wattsgard C, Borgstrom A, Lasson A, Nyman U, Ohlsson K: Pathobiochemistry and early CT findings in acute pancreatitis. Digestion 44:184–190, 1989
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pezzilli, R., Billi, P., Miglioli, M. et al. Serum amylase and lipase concentrations and lipase/amylase ratio in assessment of etiology and severity of acute pancreatitis. Digest Dis Sci 38, 1265–1269 (1993). https://doi.org/10.1007/BF01296077
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296077