The serum behavior of
amylase, pancreatic
isoamylase,
lipase,
trypsinogen, and
elastase 1 was studied in 145 patients with
pancreatic disease and in 66 patients with
abdominal pain of nonpancreatic origin, for the purpose of evaluating the relative diagnostic utility of their assays. In 34 patients with
acute pancreatitis, serum
lipase,
trypsinogen, and
elastase 1 were elevated in all 34, pancreatic
isoamylase in 33 (97%) and
amylase in 30 (88%). Ten of these
acute pancreatitis patients were followed sequentially for seven days: the variations in their serum
enzyme levels were parallel, although the
lipase,
trypsinogen, and particularly the
elastase 1 elevations persisted longer than did those of
amylase and pancreatic
isoamylase. Among the patients with
chronic pancreatitis, either in painful relapse (N = 19) or with
pancreatic cysts (N = 15), the respective percentages of
enzymes elevations were: 79 and 80% for
elastase 1, 68 and 67% for
trypsinogen, 63 and 73% for pancreatic
isoamylase, 58 and 60% for
lipase, 53 and 60% for
amylase. In the 52
chronic pancreatitis patients studied during clinical remission, serum
enzyme behavior varied greatly, and a majority of the assays (60%) were normal; even in the case of severe pancreatic exocrine insufficiency, normal as well as abnormally high and low
enzyme values were seen. Highly variable
enzyme behavior was also seen in the 40 patients with
pancreatic cancer, and
elastase I was the most frequently (35%) elevated
enzyme in this group as well. Among the patients with
abdominal pain of nonpancreatic origin, abnormally high
enzyme levels were present in percentages ranging from 6% for
lipase to 21% for
trypsinogen.(ABSTRACT TRUNCATED AT 250 WORDS)