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How often are liver function tests normal in acute biliary pancreatitis?

Kush Dholakia¹, C S Pitchumoni, N Agarwal

¹Department of Medicine, Our Lady of Mercy Medical Center, New York Medical College, Bronx, NY, USA. kush2071@cs.com

Journal of Clinical Gastroenterology

|December 18, 2003

Summary

Normal liver function tests (LFTs) occur in nearly 15-20% of acute biliary pancreatitis cases. Clinicians should not rule out biliary causes based solely on normal LFTs in patients with acute pancreatitis.

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Area of Science:

Gastroenterology
Hepatology
Internal Medicine

Background:

Biochemical markers for biliary acute pancreatitis (AP) typically include elevated ALT (>3x ULN) and total bilirubin (>3 mg%).
However, the frequency of normal liver function tests (LFTs) in biliary AP is not well-established.

Purpose of the Study:

To determine the incidence of normal LFTs (bilirubin, ALP, ALT, AST) in patients diagnosed with biliary AP.

Main Methods:

A prospective analysis of data from 269 patients with biliary AP (out of 728 total AP cases) over 20 years.
Biliary etiology was confirmed by gallstones identified via ultrasound or during surgery.

Main Results:

Normal bilirubin, AST, ALT, and ALP were observed in 14.5%, 12.3%, 11.2%, and 26.4% of biliary AP cases, respectively.

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Collectively, 10.4% of patients had normal values across all four LFTs.

Additionally, 16.7% had ALT <3x ULN and 43.5% had total bilirubin <3 mg%.

Conclusions:

A significant proportion (15-20%) of biliary AP patients present with normal LFTs.
Normal LFTs should not preclude the consideration of a biliary etiology in acute pancreatitis.