Can We Detect Chronic Pancreatitis With Low Serum Pancreatic Enzyme Levels?

Abstract

Objectives The aims of this study were to evaluate whether serum pancreatic enzyme levels could be used to aid screening for chronic pancreatitis (CP). Methods 170 healthy volunteers were screened and prospectively enrolled in the control group. 150 patients who were diagnosed with calcific CP were enrolled in the patient group by retrospective review. Serum amylase and lipase levels were compared between the 2 groups. Results The mean values ± SD of the control group were compared with those of the patient group for serum amylase level (48.1 ± 13.2 vs 34.8 ± 17.2 U/L, P < 0.001) and serum lipase level (26.4 ± 11.3 vs 16.3 ± 11.2 U/L, P < 0.001). On the receiver operating characteristic curve analysis for amylase level, area under the curve was 0.740 (95% confidence interval), and sensitivity and specificity were 38.7% and 94.1%, respectively, with a cutoff value of 27.5 U/L. On the receiver operating characteristic curve analysis for lipase level, area under the curve was 0.748 (95% confidence interval), and sensitivity and specificity were 33.3% and 95.9%, respectively, with a cutoff value of 10.5 U/L. Conclusions Our results suggest that low serum pancreatic enzyme levels can be used to aid in detection of CP.

Low Serum Pancreatic Amylase and Lipase Values Are Simple and Useful Predictors to Diagnose Chronic Pancreatitis

“…Healthy paid volunteers were screened and prospectively enrolled in the control group. 8 Consecutive patients who were diagnosed with chronic pancreatitis at Indiana University Hospital were selected from the Indiana University endoscopic retrograde cholangiopancreatography (ERCP) database during the period between December 2012 and November 2015 and enrolled in the patient groups. Patients with chronic pancreatitis were divided into NCCP and CCP group based on the presence or absence of calcification seen on computed tomography (CT) scan, plain abdominal X-ray or ERCP.…”

“…4 – 7 In a recent study, low serum pancreatic lipase value was a useful indicator for the discrimination of established calcific chronic pancreatitis (CCP) versus healthy controls (H). 8 The low lipase finding is of less diagnostic value since the diagnosis is obvious via calcification. To date, few studies addressed the diagnostic role of serum amylase and lipase in the discrimination of chronic pancreatitis at the non-calcific stage of disease from H. This study aimed to evaluate the diagnostic role of low serum pancreatic amylase and lipase values in the detection of non-calcific chronic pancreatitis (NCCP).…”

Pancreas‐specific plasma amylase for assessment and diagnosis of chronic pancreatitis: New insights on an old topic

“…Many previous studies have investigated plasma and serum levels of pancreatic enzymes in the context of pancreatic disorders including CP; while high amylase levels are typically seen in patients with acute pancreatitis, 13 low enzyme levels have consistently been reported across studies in patients with CP and pancreatic cancer and these observations are in line with our findings. 6,14,15,8 However, most previous studies were based on analysis of plasma amylase that was not specific for pancreas, used outdated laboratory technologies and disease classification systems, and did not systematically investigate the associations among plasma amylase levels, EPI and DM. We documented that EPI and DM were independently associated with plasma amylase levels, and these associations were not solely driven by disease duration, as both EPI and DM remained significantly and independently associated with plasma amylase levels in multivariate analysis.…”

Recent advances in the diagnosis and management of chronic pancreatitis

“…Two recent studies reported low serum amylase and lipase levels in patients with advanced chronic calcific pancreatitis or non-calcific chronic pancreatitis compared with healthy controls [18,19]. According to those studies, when serum amylase and lipase levels are lower than the normal range, the specificity to diagnose chronic pancreatitis is 100%, once the patient’s status with post-pancreatectomy (partial or complete) are excluded.…”