From the Guidelines
Lipase is typically not elevated in gallbladder disease alone, such as cholecystitis, unless there is secondary pancreatic involvement. While lipase is a pancreatic enzyme that can be elevated in pancreatic conditions, gallbladder diseases such as cholelithiasis (gallstones) or cholecystitis (gallbladder inflammation) generally do not cause significant lipase elevation unless there is secondary pancreatic involvement, as seen in cases of gallstone pancreatitis 1. In such cases, lipase levels will rise significantly, often 3-5 times the upper limit of normal, due to the blockage of the common bile duct causing pancreatic enzymes to back up into the pancreas, leading to autodigestion and inflammation.
The diagnosis of acute calculus cholecystitis (ACC) is typically based on a combination of detailed history, complete clinical examination, laboratory tests, and imaging investigations, with useful features including fever, right upper quadrant pain or tenderness, vomiting or food intolerance, Murphy’s sign, elevated C-reactive protein, and elevated white blood cell count 1. Imaging studies such as ultrasound, CT scan, or MRCP are more valuable for diagnosing gallbladder conditions than lipase levels.
When evaluating gallbladder disease, clinicians typically look for elevated liver enzymes (ALT, AST), alkaline phosphstolo, and bilirubin rather than lipase 1. The 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis do not recommend lipase as a primary diagnostic marker for ACC, instead focusing on other laboratory tests and imaging features 1.
In summary, lipase elevation is not a reliable marker for cholecystitis unless there is secondary pancreatic involvement, and clinicians should rely on other diagnostic markers and imaging studies to diagnose gallbladder disease.
From the Research
Lipase Levels in Cholecystitis
- Lipase levels can be elevated in various intra-abdominal inflammatory conditions, including cholecystitis 2.
- A study on serum pancreatic enzyme assays in diagnosis of pancreatic disease found that lipase levels were elevated in some patients with abdominal pain of nonpancreatic origin, including those with gallstone disease 3.
- However, another study on the usefulness of serum amylase and lipase as predictors of the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis found that serum lipase levels correlated with the presence and severity of pancreatitis, but did not specifically address cholecystitis 4.
- A study on serum lipase, alpha-amylase, and pancreatic amylase in gallstone diseases found that serum lipase results were inconclusive, but pancreatic amylase was significantly associated with gallstone disease 5.
- Elevated pancreatic enzymes, including lipase, have been found in patients with inflammatory bowel disease, particularly those with extensive disease 6.
Association with Cholecystitis
- While there is evidence that lipase levels can be elevated in various intra-abdominal inflammatory conditions, the specific association with cholecystitis is not well-established 2, 3.
- The study on gallstone diseases found a significant association between pancreatic amylase and gallstone disease, but the results for serum lipase were inconclusive 5.
- Further research is needed to determine the relationship between lipase levels and cholecystitis.