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

Abstract

Background Pancreatic function testing and imaging are used to inform the diagnosis of chronic pancreatitis, but most of these methods are time- and cost-consuming or lack diagnostic accuracy. Objective We investigated the utility of pancreas-specific plasma amylase for assessment and diagnosis of chronic pancreatitis. Design This was a prospective study of 121 consecutive patients with chronic pancreatitis and a reference population of 94 healthy controls. Pancreas-specific plasma amylase level was determined and analysed for its association with exocrine pancreatic insufficiency, diabetes and other clinical variables. Receiver operating characteristic curve analyses were performed to determine the diagnostic utility of plasma amylase for diagnosing chronic pancreatitis and to study associations with disease severity. The findings were validated in a further cohort of 57 patients with chronic pancreatitis. Results Significant and independent associations between plasma amylase level and duration of chronic pancreatitis as well as the presence of exocrine pancreatic insufficiency and diabetes were observed (all p < 0.001). An amylase level below 17.3 U/l had a high specificity (94%) and moderate sensitivity (59%) for the diagnosis of chronic pancreatitis. Diagnostic performance was influenced by disease stage with the best performance observed for advanced disease. The findings were replicated in the validation cohort. Conclusion Pancreas-specific plasma amylase may provide a clinically useful mean for assessment and diagnosis of chronic pancreatitis.

Clinical and biochemical characteristics of postpancreatitis diabetes mellitus: A cross‐sectional study from the Danish nationwide DD2 cohort

“…27 This is further supported by the finding that PPDM patients had lower plasma amylase levels, which has been associated with pancreatic exocrine insufficiency. 25 We did not observe any clear separation of PPDM from T2D in relation to parameters of glucose metabolism when plotting HOMA parameters for individual subjects. Also, in the group-based analysis patients with PPDM-A were largely indistinguishable from T2D.…”

“…A cutoff <17 U/L was used to define patients with a low amylase level. 25 The remaining biochemical parameters (triglycerides, HbA1c, and urine albumin/creatinine ratio) were collected from linked medical and administrative registries. 18…”

Pathological Mechanisms in Diabetes of the Exocrine Pancreas: What’s Known and What’s to Know

“…The current proposed diagnostic criteria include evidence of pancreatic exocrine disease such as functional insufficiency (identified with tests of the fecal elastase-1 or exocrine pancreatic function) and pathological changes of pancreatic imaging [computerized tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound], as well as potential alterations in incretin secretion and decreased levels of fat soluble vitamins (A, D, E, and K) in serum (Ewald and Bretzel, 2013;Wynne et al, 2019). In addition, certain novel biomarkers showed potential in discriminate DEP from other diabetes (Olesen et al, 2019;Bharmal et al, 2020b;Gold-Smith et al, 2020).…”

Clinical Guidelines of the Russian Society of Surgeons, the Russian Gastroenterological Association, the Association of Surgeons-Hepatologists and the Endoscopic Society “REndO” on Diagnostics and Treatment of Chronic Pancreatitis

“…Определение активности альфа-амилазы, липазы в сыворотке крови не является диагностическим маркером ХП, но его определение рекомендуется пациентам с ХП в первые сутки госпитализации и в дальнейшем в динамике в течение одной госпитализации для диагностики осложнений и рецидива острого панкреатита на фоне ХП [48][49][50].…”