The Incidence of Normal Amylase Level in Children with Acute Pancreatitis

Objective: The diagnosis of acute pancreatitis needs at least 2 of 3 following criteria: 1. Clinical symptoms. 2. An elevation in serum amylase or/and lipase levels > 3 times upper normal limit. 3. Radiologic findings.

Aims: To find the incidence of normal serum amylase levels among children diagnosed with acute pancreatitis.

Methods: Retrospective analysis of children diagnosed with acute pancreatitis according to above diagnostic criteria during the years 2008-2019 at the French Hospital of Nazareth, Israel.

Results: 47 children were diagnosed with ac. Pancreatitis (63.8% females, age 2-18 years, median 8 years). 80% of diagnosed children were with high serum lipase levels compared to 42.5% with high serum amylase levels (> 3 of upper normal limit) (P <0.05). 89.3% were found with high urine amylase levels and 89.1% were with an increased serum amylase levels above upper normal limit (> 110u/l). 46.8% of these 89.1% were between 110-330 u/l.

Discussion: According to our results, serum lipase levels still considered accurate for diagnosis of acute pancreatitis. Urine amylase levels were also found valuable in diagnosis.

If we base our diagnosis only on serum amylase levels, we will miss out 46.8% of children with ac. Pancreatitis.

In case we consider all pathological serum amylase levels (above 110 u/l) we may diagnose 89.1% of the patients. Still, all pathological serum amylase levels need further evaluation to exclude other amylase sources than pancreas and false positive results.

Conclusion: The laboratory criteria needed for diagnosis of acute pancreatitis should be reevaluated. Large studies are needed