Serum amylase or lipase to diagnose pancreatitis in patients presenting with abdominal pain.
Date First Published:
March 1, 2000
Last Updated:
September 16, 2002
Report by:
John Butler, Specialist Registrar (Manchester Royal Infirmary)
Search checked by:
Kevin Mackway-Jones, Manchester Royal Infirmary
Three-Part Question:
In [patients with abdominal pain] is [a single serum lipase better than a serum amylase] as [a diagnostic marker of pancreatitis]?
Clinical Scenario:
A 45 year old female attends the emergency department with a four hour history of acute onset of epigastric pain. She has a history of alcohol usage. On examination you can elicit tenderness in the epigastrium but no peritonism. You are concerned that the patient may have pancreatitis. You wonder whether a serum lipase might be better than serum amylase as a diagnostic marker for pancreatitis in this patient.
Search Strategy:
Medline and EMBASE 1966-06/02 using the OVID interface.
Search Details:
[{exp Abdominal pain OR abdominal pain.mp} OR {exp Pancreatitis OR exp Pancreatitis, Acute Necrotizing OR exp pancreatitis, alcoholic OR pancreatitis.mp} AND {exp Amylases OR amylase.mp} AND {exp Lipase OR lipase.mp} AND exp Diagnosis OR diagnosis.mp] LIMIT to human AND English.
Outcome:
320 papers were found in total of which 313 were irrelevant or of insufficient quality for inclusion. The remaining 7 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Diagnostic assays in Acute Pancreatitis. Steinberg WM, Goldstein SS, Davis ND et al. 1985, USA | 166 patients with abdominal pain. 39 cases with confirmed pancreatitis v 127 Emergency dept attenders with abdominal pain. Gold standard - CT findings, ultrasound or laparotomy | Diagnostic study | Lipase upper limit | Spec 99%. Sens 86%. | Different gold standards Selected patient groups |
| Amylase upper limit | Spec 89%. Sens 95%. | ||||
| Lipase best cut off | Spec 99%. Sens 87%. | ||||
| Amylase best cut off | Spec 99%. Sens 95%. | ||||
| Diagnostic and prognostic utility of phospholipase A activity in patients with acute pancreatitis: comparison with amylase and lipase. Kazmierczak SC, Van Lente F, Hodges ED. 1991, USA | 151 consecutive patients on whom serum amylase or lipase had been ordered | Diagnostic study | Diagnosis of pancreatitis | Similar ROC curves for amylase and lipase. | No gold standard Not all patients had test |
| Serum lipase levels in nonpancreatic abdominal pain versus acute pancreatitis. Gumaste VV, Roditis N, Mehta D et al. 1993, USA | 170 patients with abdominal pain | Diagnostic study | Lipase | Spec 99%. Sens 100%. | No gold standard Unblinded |
| Amylase | Spec 99%. Sens 72%. | ||||
| Amylase, lipase, pancreatic isoamylase, and phospholipase A in diagnosis of acute pancreatitis. Clave P, Guillaumes S, Blanco I et al. 1995, Spain | 384 patients admitted with abdominal pain | Diagnostic study | Diagnosis of pancreatitis | Area under ROC curve similar for serum amylase and lipase. | No gold standard Admitted patients |
| Serum amylase and lipase in the evaluation of acute abdominal pain. Chase CW, Barker DE, Russell WL et al. 1996, USA | 306 patients admitted with abdominal pain. | Diagnostic study | Lipase | Diagnostic efficiency 94% | No gold standard |
| Amylase | Diagnostic efficiency 91% | ||||
| Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. Kemppainen EA, Hedstrom JI, Puolakkainen PA et al. 1997, Finland | 500 consecutive patients with abdominal pain attending Emergency Departments in 2 centres | Diagnostic study | Lipase | Sens 94%, Spec 95% | |
| Amylase | Sens 85%, Spec 91% | ||||
| A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain. Keim V, Teich N, Fielder F et al. 1998, Germany | 253 patients with acute abdominal painGold standard was CT scan/US scan of abdomen abdominal pain | Diagnostic study | Diagnosis of pancreatitis | Amylase sensitivity of 95% at 0-1 days, lipase 100%. ROC curve slightly superior for lipase. |
Author Commentary:
Concern has been expressed about the use of serum amylase to diagnose pancreatitis. Hyperamylasaemia has been reported in numerous abdominal conditions that can be confused with pancreatitis. Acute pancreatitis has also been reported in patients with a normal amylase. The studies mentioned suggest that serum amylase and lipase both have high levels of sensitivity and specifictiy for pancreatitis, although few studies looked directly at patients attending the emergency department with abdominal pain. On the whole comparative studies show serum lipase to be slightly superior to amylase as a diagnostic marker when used to rule in or out pancreatitis. Further work is needed to look at diagnostic assays in patients attending the emergency department with abdominal pain.
Bottom Line:
Serum amylase and lipase are high sensitivity and specific diagnostic markers of acute pancreatitis. Some studies suggest serum lipase is better.
References:
- Steinberg WM, Goldstein SS, Davis ND et al.. Diagnostic assays in Acute Pancreatitis.
- Kazmierczak SC, Van Lente F, Hodges ED.. Diagnostic and prognostic utility of phospholipase A activity in patients with acute pancreatitis: comparison with amylase and lipase.
- Gumaste VV, Roditis N, Mehta D et al.. Serum lipase levels in nonpancreatic abdominal pain versus acute pancreatitis.
- Clave P, Guillaumes S, Blanco I et al.. Amylase, lipase, pancreatic isoamylase, and phospholipase A in diagnosis of acute pancreatitis.
- Chase CW, Barker DE, Russell WL et al.. Serum amylase and lipase in the evaluation of acute abdominal pain.
- Kemppainen EA, Hedstrom JI, Puolakkainen PA et al.. Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis.
- Keim V, Teich N, Fielder F et al.. A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain.