Support of the diagnosis of pancreatitis by enzyme tests--old problems, new techniques

Computerized tomography and ultrasound are helpful in the diagnosis of acute pancreatitis. The procedures, however, are not always available and so laboratory tests continue to play an important role. Serum amylase measurement is the most widely used test, despite its lack of sensitivity (75-92%) and specificity (20-60%). A cut-off point of 3-6 times the upper reference limit increases the specificity greatly, but at the expense of sensitivity. A method using chloronitrophenyl-maltotrioside as substrate has recently been rejected by the IFCC. A method using ethylidene-protected 4-nitrophenyl-maltoheptaoside and a new alpha-glucosidase has emerged as the method of choice. Amylase isoenzyme determinations have higher specificity than total amylase measurements. Serum lipase methods are more sensitive and specific, but methodological problems persist. Cationic trypsin-1 measurements yield high sensitivity but low specificity. Elastase-1 is claimed to correlate best with the clinical symptoms. Reasons for the widely differing reports on sensitivity and specificity of tests for pancreatitis are discussed.