A normal serum
amylase level is found in up to 32% of patients with acute
alcoholic pancreatitis. This underlines the need for more sensitive diagnostic tests in this frequent cause of
pancreatitis. Animal and human studies have shown that chronic alcohol consumption leads to important modifications in
trypsinogen metabolism. The present work has prospectively analyzed admission serum
trypsin activity with a new biochemical test and usual markers such as
amylase,
lipase, and immunoreactive
trypsin in 32 attacks of
acute pancreatitis. Seventeen were due to alcohol and 15 to other causes, including 11 with
gallstone pancreatitis. High
trypsin activity (median: 235 units/liter; range: 165-853) was found in all patients with acute
alcoholic pancreatitis even when the
amylase level was normal on admission (3/17: 18%).
Trypsin activity did not differ between nonalcoholic
pancreatitis (N = 15): 84 units/liter (42-98), alcoholic controls (N = 15): 77 units/liter (40-122), and healthy controls (N = 62): 81 units/liter (15-143). The difference was not related to the severity of disease or circulating
alpha 2-macroglobulin,
alpha 1-protease inhibitor, or immunoreactive
trypsinogen levels.
Lipase/
amylase ratio was less discriminant than
trypsin activity between alcoholic and nonalcoholic diseases. We conclude that serum
trypsin activity seems specific to acute
alcoholic pancreatitis and should be included in new prospective studies assessing biochemical testing of alcohol-related
pancreatic diseases.