Raised Amylase and Lipase: What Does It Mean?

Amylase and lipase are enzymes used above all in assessing disease of the pancreas.

Finding one or both of them raised on a blood test often leads people to worry: “Have I got pancreatitis?” But there is an important point here.

A raised amylase or lipase is not on its own a diagnosis of pancreatitis.

What the result means is judged by how far the enzyme has risen, your symptoms, the examination findings, the medicines you take and, where needed, imaging.

What is amylase?

Amylase is an enzyme involved in the digestion of carbohydrates. It is produced mainly by:

• The pancreas
• The salivary glands

So a raised blood amylase does not always come from the pancreas.

What is lipase?

Lipase is an enzyme that helps digest fats, and in clinical assessment it matters particularly for conditions involving the pancreas.

Where acute pancreatitis is suspected, lipase is generally a more pancreas-specific test than amylase. Even so, a raised lipase does not on its own mean pancreatitis.

Why do amylase and lipase rise?

The cause that comes to mind first is acute pancreatitis, but it is not the only one. Conditions that can raise these enzymes include:

• Acute pancreatitis
• Some chronic diseases of the pancreas
• Gallstones and diseases of the bile ducts
• Impaired kidney function
• Some diseases of the stomach and bowel
• Serious intra-abdominal conditions such as bowel obstruction or ischaemia
• Some medicines

Amylase can also rise in diseases of the salivary glands.

Does a raised amylase or lipase mean I have pancreatitis?

No.

A diagnosis of acute pancreatitis is not made from a blood test alone. In general, at least two of the following three findings are looked for:

• Abdominal pain typical of acute pancreatitis
• Amylase and/or lipase raised to roughly three times the upper limit of normal or more
• Findings consistent with acute pancreatitis on imaging

So a mildly raised lipase is not the same situation as a patient with typical abdominal pain whose lipase is several times the upper limit.

Does it matter how high the enzyme is?

Yes.

Values a little above the laboratory’s upper limit can arise for many different reasons. For example:

• Lipase: upper limit 60 U/L → result 75 U/L
• Lipase: upper limit 60 U/L → result 600 U/L

are not judged in the same way.

But there is no rule that the higher the number, the more severe the illness must be. The enzyme level does not on its own show how severe a pancreatitis is.

Can lipase be high while amylase is normal?

Yes.

In acute pancreatitis lipase can be raised while amylase is normal. When in the course of the illness the test was taken, kidney function and other factors can also affect the results.

So the two tests do not have to rise together.

Can amylase be high while lipase is normal?

Yes.

Because amylase is produced outside the pancreas as well, a raised amylase has causes that have nothing to do with the pancreas. Salivary gland disease is one of them.

There is also a harmless condition called macroamylasaemia, which can sometimes cause a long-standing raised amylase.

Can medicines raise amylase or lipase?

Yes.

Pancreatic enzymes can rise while some medicines are being taken. This is why it matters that you tell your doctor about:

• Prescribed medicines
• Over-the-counter medicines
• Vitamins and supplements

Does lipase rise on GLP-1 medicines?

Amylase and lipase levels can rise while some GLP-1 receptor agonists used in the treatment of obesity and diabetes are being taken.

A raised enzyme with no symptoms is not on its own a diagnosis of acute pancreatitis. But in someone taking these medicines, new and persistent severe abdominal pain — particularly with vomiting — needs medical assessment.

Which investigations may be done?

Not every patient needs the same tests. Your doctor will first assess:

• Whether there is abdominal pain
• Where the pain is and how severe
• Nausea and vomiting
• A history of gallstones
• Alcohol use
• The medicines you take
• Previous disease of the pancreas
• Kidney function
• Other blood tests

If needed, abdominal ultrasound, computed tomography (CT), magnetic resonance imaging (MRI/MRCP) or endoscopic ultrasound (EUS) may be used.

Not every raised amylase or lipase needs a CT, an MRI or an EUS.

If it is only slightly high, does the test need repeating?

In some people a mildly raised enzyme is temporary. Depending on the clinical picture your doctor may want to repeat the test or request other investigations.

But rather than measuring the same result over and over, what matters is weighing the cause of the rise together with the clinical findings.

When is urgent assessment needed?

Assessment may be needed without delay if a raised amylase or lipase is accompanied by any of the following:

Sudden, severe upper abdominal pain spreading to the back, together with nausea and vomiting, particularly calls for assessment for acute pancreatitis.

It came back high but I have no symptoms. What should I do?

Do not panic; but do not ignore the result entirely either.

Pancreatic enzymes can be found raised for various reasons in people with no symptoms at all.

Your doctor decides whether further investigation is needed by weighing how high the value is, previous results, the medicines you take, your kidney function and your other laboratory findings.

Remember

• A raised amylase or lipase is not on its own pancreatitis.
• A mild rise can have many different causes.
• A rise to three times normal or more, together with typical pain, matters for acute pancreatitis.
• A very high enzyme does not necessarily mean the illness is severe.
• Severe abdominal pain with vomiting needs assessment without delay.