Gastroenteritis-Associated Hyperamylasemia: Prevalence and Clinical Significance
May 30, 2002
Gastroenteritis-Associated Hyperamylasemia: Prevalence and Clinical Significance
Abstract & Commentary
Synopsis: Mild-to-moderate elevations of serum amylase can be associated with nonspecific gastroenteritis.
Source: Ben-Horin S, et al. Arch Intern Med. 2002;162:689-692.
Clinicians have come to depend on serum amylase elevations as a useful index for inflammation of the pancreas. It is known that "spurious" amylase elevations can occur in certain other conditions such as salivary gland disease, intestinal perforation, and renal failure. Although gastroenteritis is not widely appreciated as a cause of amylase elevation, there have been a few reports that suggest this association. Ben-Horin and colleagues describe findings from 1041 patients with a diagnosis of acute gastroenteritis in a hospital emergency department. Amylase values were available for 67% of patients, and 9.4% were found to have elevated amylase values up to 2.2 times normal. Of these patients, many had normal prior amylase levels before their hospital referral for gastroenteritis; others had normal follow-up amylase results within a month after these acute episodes. The amylase values did not correlate with clinical course, nor was there any relation to age or sex or other laboratory parameters. It was speculated that hyperamylasemia could be due to pancreatic inflammation occurring as part of the infectious inflammatory gastroenteritis process. Alternatively, and perhaps more likely, increased mucosal permeability during gastroenteritis could allow backflow of pancreatic enzymes from the gut lumen to the bloodstream.
Comment by Malcolm Robinson MD, FACP, FACG
This study is of interest to clinicians and provides a useful perspective on the possible association of elevated amylase values and acute gastroenteritis—in the absence of clinically relevant pancreatic disease. These observations are limited by their retrospective nature, but it seems likely that they would be confirmed by a suitable prospective study. In patients with apparent gastroenteritis and amylase values up to twice normal, it would be reasonable to assume that such enzyme elevations are nonspecific and that they need not mandate further pancreatic evaluation or any unusual therapeutic intervention.
Dr. Robinson, Medical Director, Oklahoma Foundation for Digestive Research; Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, is Associate Editor of Internal Medicine Alert.
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