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Serum amylase or lipase to diagnose pancreatitis in patients presenting with abdominal pain
  1. John Butler, Specialist Registrar,
  2. Kevin Mackway-Jones, Professor
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether serum amylase was better than serum lipase in the diagnosis of pancreatitis in patients presenting with abdominal pain. Altogether 320 papers were found using the reported search, of which seven presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by John Butler,Specialist RegistrarChecked by Kevin Mackway-Jones, Professor

    Clinical scenario

    A 45 year old woman attends the emergency department with a four hour history of acute onset of epigastric pain. She has a history of alcohol use. 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.

    Three part question

    In [patients with abdominal pain] is [a single serum lipase better than a serum amylase] as [a diagnostic marker of pancreatitis]?

    Search strategy

    Medline 1966–06/02 and EMBASE using OVID interface. [{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.

    Search outcome

    Altogether 320 papers were found in total of which 313 were irrelevant or of insufficient quality for inclusion. The remaining seven papers are shown in table 4.

    Table 4

    Comment(s)

    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.

    CLINICAL BOTTOM LINE

    Serum amylase and lipase are high sensitivity and specific diagnostic markers of acute pancreatitis. Some studies suggest serum lipase is better.

    Report by John Butler,Specialist RegistrarChecked by Kevin Mackway-Jones, Professor

    References

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