From the Guidelines
Elevated lipase levels should be promptly evaluated for acute pancreatitis, especially if accompanied by abdominal pain, nausea, or vomiting, as it requires immediate medical attention and often hospitalization for pain management and other supportive care. The diagnosis of acute pancreatitis should be based on compatible clinical features and elevations in amylase or lipase levels, with lipase being more specific and preferred 1. According to the 2019 WSES guidelines, serum lipase is considered a more reliable diagnostic marker of acute pancreatitis than serum amylase, with a sensitivity and specificity of 79% and 89%, respectively 1.
Causes and Risk Factors
The most common causes of acute pancreatitis include gallstones and alcohol use, but other causes such as certain medications, kidney disease, intestinal inflammation, or pancreatic tumors should also be considered. In the absence of gallstones or significant history of alcohol use, serum triglyceride should be measured and considered to be the etiology if the value is > 11.3 mmol/l (> 1000 mg/dl) 1.
Diagnostic Approach
Elevations in lipase levels greater than 3 times the upper limit of normal, in the absence of renal failure, are most consistent with acute pancreatitis 1. Mild elevations (1-3 times normal) may occur in non-pancreatic conditions, while levels exceeding 3 times normal strongly suggest pancreatitis. Further testing, such as abdominal imaging (CT scan or ultrasound) and additional blood tests, may be necessary to determine the specific cause of elevated lipase levels.
Management
Treatment depends on the underlying cause of acute pancreatitis, and may include pain management with medications like hydromorphone or morphine, intravenous fluids, and bowel rest. For gallstone pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy may be necessary, while alcohol cessation is crucial for alcohol-induced pancreatitis. Other causes, such as certain medications or kidney disease, should be addressed accordingly.
From the Research
Causes of Elevated Lipase
- Elevated lipase can be caused by various conditions, including acute pancreatitis, chronic pancreatitis, gastrointestinal tract obstruction, malignancies, and other disease conditions 2
- In critically ill patients, elevated lipase is commonly found, and it is related to longer length of stay, but not accompanied by increased clinical severity or mortality 3
- Elevated lipase can also be caused by reduced clearance of lipase due to renal impairment or macrolipase formation, other hepatobiliary, gastroduodenal, intestinal, and neoplastic causes, critical illness, alternative pancreatic diagnoses, and miscellaneous causes such as diabetes, drugs, and infections 4
Diagnosis of Elevated Lipase
- Serum amylase and lipase tests are routinely performed in patients presenting with abdominal pain or during regular health screening 2
- A systematic approach to patients with elevated amylase and/or lipase is critical to making an accurate diagnosis and initiating appropriate treatment 2
- Contrast-enhanced computed tomography is considered the diagnostic standard for radiologic evaluation of acute pancreatitis 5
Clinical Significance of Elevated Lipase
- Elevated lipase is a significant indicator of pancreatitis, but it can also be caused by other conditions, and clinicians should be aware of the possibility of incorrect diagnosis in asymptomatic patients 4
- In some cases, acute pancreatitis can occur with normal serum lipase, as reported in a case of hydrochlorothiazide-induced pancreatitis 6
- The medical officer should utilize the knowledge of differential diagnoses for significant serum lipase elevations in the interpretation and management of patients with elevated lipase levels 4