Elevated serum amylase in patients with chronic pancreatitis: acute attack or macroamylasemia?

Background And Aim: Asymptomatic patients with chronic pancreatitis not infrequently have elevated concentrations of amylase, even though detailed examination reveals no indication of an acute exacerbation.

Methods: One hundred and eighty-six consecutive patients with chronic pancreatitis were examined clinically and, if indicated, by ultrasonography and computed tomography. In addition, all patients underwent determination of serum amylase and serum lipase as well as amylase/creatinine clearance, followed as required by a polyethylene glycol test and/or chromatography to demonstrate macroamylase.

Results: Twenty (11%) of the 186 patients had macroamylasemia, and 15 of these 20 had hyperamylasemia. In the remaining five cases the serum amylase levels were within the normal range.

Conclusions: Patients with asymptomatic chronic pancreatitis and hyperamylasemia should first be investigated for macroamylasemia, before initiating any costly or complex procedures in the attempt to demonstrate a clinically silent or only mildly symptomatic attack of their disease.