Elevated amylase, last CT scan of pelvis/abdomen normal

[LPFNYC]

Last August, I was diagnosed with GERD and put on Prevacid. The GERD was fairly severe, but the Prevacid helped greatly along with a modified low fat diet.

In November of last year, during my routine physical, my blood work showed an amylase level of 108. Since this had never happened before, my primary care physician ordered a barium contrast CT scan of my abdomen and pelvis. The results were normal.

During my routine physical this year, my amylase level was 145. My primary care physician ordered another blood test, but this time to break the amylase into p and s type.

I should say here that all my other blood work was normal. My GERD is pretty much gone, and I've been off of the Prevacid since the middle of this year. My primary care physician thought my elevated amylase might be due to macroamylasemia.

I just received a message that the latest tests are in and my PCP wants me to do another CT and sonogram of the pelvis and abdomen, since it has been a year since the last one.

But I feel fine. My question to you is why doesn't my PCP just want to leave it as macroamylasemia and do another blood work down the road? His thinking is that it's been a year, and he'd like to run another test.

Any insight would be greatly appreciated.

Thanks!

[Dr. Safaa Mahmoud]

Hello,
Amylase is a digestive enzyme concerned with carbohydrate metabolism.
Normal level is in the range of 60-180 units per liter (U/L).

So your level is not higher than normal although at the high of the normal range (if the reference lab has the same range of the above levels).
However, if it is higher the normal range for your lab reference and if it is rising, investigations should be done to exclude any underlying problem.

The main sources for amylase are the pancreas and the salivary glands.
So, hyperamylasemia is most commonly to result from (1) pancreatitis or parotitis, (2) diminished clearance of amylase, or (3) other organs amylase release.

Serum amylase levels (Amylase P) is specific to pancreatic problem. Levels of 3 times higher than normal make the diagnosis of acute pancreatitis more likely.
Lipase levels are also elevated in such patients. CT scan is of choice in the diagnosis of pancreatitis.

Other GIT problems cause also elevation in the P isoform of amylase (P-type isoamylase) like gastritis and gastric ulcer. So since you have a GERD that was controled recently, it is still the a likely cause but exclusion of other causes is improtant.

The S isoform of the amylase is elevated in diseases of the salivary gland and from the female reproductive system.
Macroamylasemia is a benign condition in which the clearance of amylase is diminished as it binds with a large complex molecule. About 2-5% of patients with hyperamylasemia have macroamylasemia.

Since the level of amylase continue to be elevated and is rising, I agree with your docotr to repeat the test checking its isoforms.
Serum isoamylase measurements would confirm if the elevated amyalse is S-type isoamylase, P-type isoamylase, or macroamylasemia.

A follow up CT scan might be a good test to exclude organ problem especially if you have symptoms or it is proved to be P-type isoamylase. However, I would advise considering an upper endoscopy to follow up the GERD status and its effect on the esophagus and the stomach, since it is your main problem and your CT Scan was negative.

Hope you find this information useful.
Please keep us updated.
Best regards.

[LPFNYC]

Hello Dr. Mahmoud,

Thanks for for your detailed reply.

I should offer a follow-up on this. The PCP did a blood draw breaking down the amylase two week after the initial test in October of this year.

The results were P-Amylase 78, Salivary Amylase 57, Total Amylase 135, which was a bit of a drop from the 145 of two weeks before.

The PCP referred us to a pancreatic specialist, whom we will visit in the next few weeks.

One last thing, during the initial GERD diagnosis an endoscopy was done (August 2007). Results were normal but excessive acid was found in the stomach lining.

In order to be a bit more informed, what should we ask this pancreatic specialist or should we just be listening at this point?

As you can see from my posting on this board, I am a big believer in educating and advocating for patients.

Again, thanks so much.