From the Guidelines
Treatment for elevated lipase should focus on addressing the underlying cause, such as acute pancreatitis, and managing hypertriglyceridemia to prevent further pancreatic damage, as evidenced by the ESPEN guidelines on parenteral nutrition 1. The goal of treatment is to maintain triglyceride levels within the normal range, and if the serum TG level cannot be maintained below 12 mmol/L, drug therapy is indicated to decrease VLDL production and prevent more severe hypertriglyceridemia. Some key points to consider in the treatment of elevated lipase include:
- Avoiding lipid emulsions if parenteral nutrition is needed in cases of hypertriglyceridemia-associated pancreatitis
- Using plasma exchange or lipoprotein apheresis to lower lipid and pancreatic enzymes levels in severe cases
- Monitoring serum triglycerides regularly if lipids are administered as part of parenteral nutrition
- Considering the use of alternative parenteral lipids such as omega-3 fatty acids, although more research is needed to confirm their clinical advantages 1. In terms of specific treatments, the use of fibric acid derivatives or fish oil may be warranted in cases of severe hypertriglyceridemia (>1,000 mg/dL) to reduce the risk of acute pancreatitis, as recommended in the Diabetes Care guidelines 1. Overall, the treatment of elevated lipase should prioritize addressing the underlying cause and managing hypertriglyceridemia to improve outcomes and prevent further pancreatic damage.
From the FDA Drug Label
12.1 Mechanism of Action Pancreatic enzyme products contain a mixture of lipases, proteases, and amylases that catalyze the hydrolysis of fats to monoglyceride, glycerol and free fatty acids, proteins into peptides and amino acids, and starches into dextrins and short chain sugars such as maltose and maltriose in the duodenum and proximal small intestine, thereby acting like digestive enzymes physiologically secreted by the pancreas.
The treatment for elevated lipase is not directly addressed in the provided drug label. However, pancrelipase is used to treat exocrine pancreatic insufficiency, which may be related to elevated lipase levels. The drug label provides information on the mechanism of action of pancrelipase, which includes the catalysis of fats, proteins, and starches into smaller components.
- Key points:
- Pancrelipase contains a mixture of lipases, proteases, and amylases.
- It acts like digestive enzymes physiologically secreted by the pancreas.
- The drug label does not provide direct guidance on treating elevated lipase levels. 2
From the Research
Treatment for Elevated Lipase
- Elevated lipase levels can be an indicator of acute pancreatitis, and treatment typically involves supportive care and management of symptoms 3.
- Enteral nutrition is preferred over parenteral nutrition in patients with acute pancreatitis, and should be initiated as early as possible (within 48 hours) 4.
- The choice of nutrition therapy in acute pancreatitis depends on the severity of the disease, and early enteral and/or oral nutrition can help mitigate the underlying inflammatory cascade of events leading to acute pancreatitis 5.
- In some cases, elevated lipase levels may not be accompanied by typical symptoms of acute pancreatitis, making diagnosis challenging 6, 7.
- Serum lipase is considered a more sensitive biomarker for diagnosing acute pancreatitis than serum amylase, and can be elevated for a longer period, making it a useful diagnostic tool in early and late stages of the disease 3.
Nutrition Therapy
- Nutrition therapy plays a crucial role in the management of acute pancreatitis, and can help mitigate the inflammatory changes in the intestinal tract and maintain intestinal bacterial composition and abundance similar to pre-disease levels 5.
- Enteral nutrition can be safely administered through a nasogastric tube in patients with severe acute pancreatitis, and can help reduce the risk of complications and improve outcomes 4.
- The use of probiotics and prebiotics in acute pancreatitis is still being researched, and their routine use cannot be recommended at this time 4, 5.