Asymptomatic elevation of serum lipase and amylase in conjunction with Crohn's disease and ulcerative colitis

Abstract

Background and objective: Elevated serum lipase and amylase are often observed in IBD patients (Crohn's disease and ulcerative colitis) without clinical symptoms of a pancreatitis. The intention of this prospective study is to evaluate the frequency of elevated serum lipase and amylase with these patients and to try to explain this phenomenon in consideration of the existing literature.

Patients and methods: 136 IBD patients (MC: 66; CU: 70) participated in this prospective study which lasted 3 months. All patients with increased levels of serum lipase and amylase were prospectively followed-up for another 3 months.

Results: We found an asymptomatic elevation of serum lipase and amylase without symptoms of a pancreatitis in 14 % of the observed IBD patients. A significance between the elevation of lipase/amylase and the activity index (CDAI,CAI) or the CRP level could not be found. A significant increase of lipase/amylase (more than twice the normal standard) was shown more often in lipase (4.4 %) than in amylase levels (0.7 %). The possible reasons for an asymptomatic increase of lipase/amylase in IBD patients (e. g. latent extra-intestinal involvement of the pancreas in IBD with pancreatitis; extra-pancreatic release of lipase/amylase from the inflammatory bowel; intestinal reabsorption of released lipase/amylase in the inflammatory bowel) are discussed in this text.

Conclusion: An asymptomatic elevation of lipase/amylase in IBD patients is not infrequent (14 %). The increase of lipase or amylase, without typical symptoms, makes a pancreatitis with a required therapy unlikely. A specific pancreatitis therapy is not necessary in these cases. The therapy should be guided by the requirements of the IBD therapy.