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Abstract
Chronic asymptomatic pancreatic hyperenzymemia (CAPH) is an increase in serum amylase and/or lipase above the upper limit of normal, confirmed 2 or more times, in the absence of symptoms and other signs of pancreatic disease.
CAPH can be associated with both pancreatic pathology and changes in other organs, and serum pancreatic enzymes can range from a slight increase (a biochemical feature that has no clinical significance) to a significant rise, sometimes caused by cancer. Unfortunately, to date, there are no guidelines for the diagnosis of CAPH in the literature, which leads to the prescription of not always rational examinations and misunderstanding on the part of patients. In this regard, we have published the algorithm of Prof. J. Enrique Dominguez-Munoz; we use this algorithm in practice, and it has proven useful and rational.
First, it is necessary to carefully ask for anamnestic data, including family history. In the case of isolated hyperamylasemia, pancreatic isoamylase and blood lipase should be determined. If there is no increase in pancreatic isoamylase and lipase, there is no reason to screen the patient for pancreatic pathology.
An indicator that helps to understand the cause of isolated hyperamylasemia is the ratio of amylase to creatinine clearances (ACC). The ACC can help to differentiate between macroamylasia (ACC <1%, i.e., reduced amylase clearance without signs of renal failure) and acute pancreatitis (ACC >4% in the first days, range 7–15%). If only salivary amylase is elevated, it is advisable to screen for risk factors for lung and ovarian cancer after excluding macroamylase and salivary gland diseases.
If serum lipase and/or pancreatic isoamylase levels are elevated, biochemical testing should first be performed to rule out renal and hepatic dysfunction. Once altered enzyme clearance/catabolism has been ruled out, increased release of the enzymes should be considered. Endoscopic ultrasound is the most sensitive method for detecting pancreatic pathology in CBPD, followed by contrast magnetic resonance imaging and magnetic resonance cholecystopancreatography.
References
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