From the Guidelines
High lipase levels in the blood are typically caused by pancreatic inflammation or damage, with acute pancreatitis being the most common cause, as supported by the 2019 WSES guidelines for the management of severe acute pancreatitis 1.
Causes of High Lipase Levels
- Acute pancreatitis, which can result from gallstones, alcohol abuse, certain medications, high triglyceride levels, or viral infections
- Chronic pancreatitis
- Pancreatic cancer
- Kidney disease
- Intestinal obstruction
- Peptic ulcer disease
- Certain abdominal injuries
- Some medications like opiates, certain antibiotics, and birth control pills ### Diagnosis and Treatment
- Diagnosis is based on compatible clinical features and elevations in amylase or lipase levels, with lipase being more specific and preferred 2
- Treatment depends on the underlying cause but may include fasting to rest the pancreas, intravenous fluids, pain management, and addressing the primary condition
- Lipase is an enzyme produced mainly by the pancreas that helps digest fats in the small intestine, so elevated blood levels typically indicate that the enzyme is leaking from damaged pancreatic cells into the bloodstream rather than being released into the digestive tract where it normally functions ### Important Considerations
- The 2019 WSES guidelines recommend using lipase as the preferred diagnostic marker for acute pancreatitis due to its higher sensitivity and larger diagnostic window 1
- A Cochrane revision found that serum lipase has a sensitivity and specificity of 79% and 89%, respectively, for the diagnosis of acute pancreatitis 1
- Contrast-enhanced CT-scan is the fastest and most comprehensive technique for evaluating duodeno-pancreatic injuries, but may not always detect pancreatic ductal injuries, especially within 12 hours of injury 3
From the Research
High Lipase Causes
- High lipase levels can be caused by various conditions, including pancreatic and non-pancreatic diseases 4, 5
- Intra-abdominal inflammatory conditions, such as pancreatitis, can lead to elevated serum lipase levels 4
- Other causes of high lipase levels include: + Reduced clearance of lipase due to renal impairment or macrolipase formation 5 + Hepatobiliary, gastroduodenal, intestinal, and neoplastic causes 5 + Critical illness, including neurosurgical pathology 5 + Alternative pancreatic diagnoses, such as non-pathological pancreatic hyperenzymaemia 5 + Miscellaneous causes, such as diabetes, drugs, and infections 5
- It's essential to consider these alternative causes when interpreting high lipase levels to avoid misdiagnosis 5, 6
Diagnosis and Treatment
- The diagnosis of acute pancreatitis requires two of the following: upper abdominal pain, amylase/lipase ≥ 3 × upper limit of normal, and/or cross-sectional imaging findings 6
- Treatment priorities include intravenous fluid resuscitation, analgesia, and enteral nutrition, as well as critical care and organ support when necessary 6
- Opioids, such as morphine, are commonly used for pain management in acute pancreatitis, but their use may worsen the severity of the disease and prevent pancreatic regeneration 7, 8