Asymptomatic Chronic Elevation of Serum Pancreatic Enzymes
How to Deal with It?
Giuseppe Vanella
Pancreas Translational and Clinical Research Center, Division of Pancreato-Biliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorPaolo Giorgio Arcidiacono
Pancreas Translational and Clinical Research Center, Division of Pancreato-Biliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorGabriele Capurso
Pancreas Translational and Clinical Research Center, Division of Pancreato-Biliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorGiuseppe Vanella
Pancreas Translational and Clinical Research Center, Division of Pancreato-Biliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorPaolo Giorgio Arcidiacono
Pancreas Translational and Clinical Research Center, Division of Pancreato-Biliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorGabriele Capurso
Pancreas Translational and Clinical Research Center, Division of Pancreato-Biliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorJ. Enrique Domínguez-Muñoz MD, PhD
Director
Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorSummary
Chronic asymptomatic pancreatic hyperenzymemia (CAPH) may be associated with different clinical circumstances, both pancreatic and extrapancreatic, ranging from a laboratory abnormality without clinical significance to the rare eventuality of an association with neoplastic lesions. This chapter summarizes the clinical circumstances that can initiate CAPH and provides an algorithm for clinical management. Up to 20% of patients with inflammatory bowel disease have been reported to present pancreatic hyperenzymemia without overt pancreatic disease. These enzyme elevations can be explained by subclinical extraintestinal involvement of the pancreas and by drug-induced hyperenzymemia, but some authors have proposed a more general mechanism based on increased reabsorption of amylase or lipase through the inflamed “leaky” gut. In 1978, different authors began reporting cohorts of patients with chronic increases in serum pancreatic enzymes. This elevation was frequently of nonpancreatic origin and that when isoenzyme profiling presumed a pancreatic origin, it often occurred in the absence of pancreatic abnormalities.
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