Lipase is The Enzyme to search for in A Suspected Acute Pancreatitis, Not Amylase

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19 Sep 2016 - General

 Following an injury to the pancreas, amylase and lipase are digestive enzymes normally released from the acinar cells of the exocrine pancreas into the duodenum. These enzymes are released into the circulation. While amylase is cleared in the urine, lipase is reabsorbed back into the circulation. In cases of acute pancreatitis, serum activity for both enzymes is greatly increased.
 Serum lipase is now the preferred test by the American Society of Clinical Pathology due to its improved sensitivity, particularly in alcohol-induced pancreatitis. Its prolonged elevation creates a wider diagnostic window than amylase. In acute pancreatitis, amylase can rise rapidly within 3–6 hours of the onset of symptoms and may remain elevated for up to five days. Lipase, however, usually peaks at 24 hours with serum concentrations remaining elevated for 8–14 days. This means it is far more useful than amylase when the clinical presentation or testing has been delayed for more than 24 hours.
 Current guidelines and recommendations indicate that lipase should be preferred over total and pancreatic amylase for the initial diagnosis of acute
pancreatitis and that the assessment should not be repeated over time to monitor disease prognosis. Repeat testing should be considered only when the patient has signs and symptoms of persisting pancreatic or peripancreatic inflammation, blockage of the pancreatic duct or development of a pseudocyst. Testing both amylase and lipase is generally discouraged because it increases costs while only marginally improving diagnostic efficiency compared to either marker alone.

*According to the American Society for clinical Pathology

Thank you for sharing this valuable information. I personally am unaware that the latest guidelines recommend the use of lipase to evaluate pancreatic injury over amylase. Amylase is still the marker we still use to diagnose pancreatic disorders and evaluate the response to management. We hardly even order lipase. I fact, I am not sure if we even have the equipment to test serum lipase in my hispital. Aparenlty the way we have been managing patients with pancreatic disorders is all outdated and ...
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