A recent cross-sectional pediatric study (SH Orkin et al. J Pediatr 2019; 213: 143-8), with a prospective clinical database, provides data on children presenting with acute pancreatitis, n=112 (2013-16).
Acute pancreatitis (AP): requires at least 2 of 3 criteria:
- Abdominal pain consistent with AP
- Serum amylase and/or lipase activity at least 3 times ULN
- Imaging findings compatible with AP
- Among AP patients who had a lipase level, the sensitivity was 95% whereas the sensitivity for amylase was 39%.
- Among AP patients who had an ultrasound, the sensitivity was 52%. In those with either CT or MRI, the sensitivity was 78%.
- In this cohort, 5.4% did not meet diagnostic criteria based on biochemical elevation (amylase or lipase) and instead relied on imaging along with signs/symptoms.
The authors note that lipase has a delayed peak and longer duration of elevation with AP. Amylase normalizes more rapidly.
My take: This study reinforces the view that an elevated lipase is more sensitive than amylase and that imaging (especially ultrasound) is frequently normal in AP.
Related blog posts:
- Consensus Pancreatitis Recommendations | gutsandgrowth
- Why an ERCP Study Matters to Pediatric Care
- Pancreatitis Update (part 1) | gutsandgrowth
- For the pediatric pancreatologists
- Chronic Pancreatitis in Pediatrics -Descriptive Study | gutsandgrowth
- INSPPIRE for pancreatitis | gutsandgrowth
- Does pancreas divisum cause pancreatitis? | gutsandgrowth
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