Lipase and Amylase Levels in Pediatric Gastrointestinal Health

Lipase and Amylase

Dear Deputy Director:
Last August, my child had acute gastroenteritis, and during the emergency visit, the lipase and amylase levels were elevated.
After the follow-up visit, an abdominal ultrasound was performed at the end of August, which showed normal results.
The doctor advised us to return in March for blood tests to check the two enzyme levels.
In early March, he had his blood drawn half an hour after breakfast (since the order did not specify fasting), and the lipase was 430, with amylase over 200.
Three days later, during the follow-up visit, the doctor ordered another blood test, which was done two hours after dinner, resulting in lipase at 243 and amylase at 108.
The doctor provided an analysis and mentioned that another ultrasound would be performed, and if necessary, an endoscopic ultrasound (EUS) would also be considered.
I would like to ask: Is fasting necessary for these two enzyme tests? Additionally, my child does not smoke or drink, has a typical college student schedule with occasional late nights, and maintains a normal diet.
He has never exhibited symptoms of acute or chronic pancreatitis, and the abdominal ultrasound last August was normal.
Should we consider a CT or MRI? Which of these tests should we choose over EUS? Would non-invasive options be more suitable for asymptomatic individuals?

linlian, 50~59 year old female. Ask Date: 2023/03/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

If a blood test for lipase and amylase levels is to be conducted, it is generally recommended to fast for 8 hours prior to the blood draw to avoid food interference with the results.
Additionally, if the child does not exhibit symptoms of pancreatitis, has a normal abdominal ultrasound, and currently shows no significant symptoms, there may be no need for immediate further imaging studies such as CT or MRI.
Endoscopic ultrasound (EUS) is an invasive examination method that can provide a clearer view of the pancreas and surrounding structures, but the necessity for EUS should be determined by the physician based on clinical judgment.
It is advisable to consult the attending physician to understand the child's current condition and the most appropriate examination method.

Reply Date: 2023/03/19

More Info

Understanding the levels of lipase and amylase in pediatric gastrointestinal health is crucial, especially in the context of acute gastroenteritis and potential pancreatic issues. Lipase and amylase are enzymes produced by the pancreas and salivary glands, respectively, and are commonly measured to assess pancreatic function and diagnose conditions such as pancreatitis.

In your case, the child experienced elevated levels of lipase and amylase following an episode of acute gastroenteritis. It is important to note that elevated lipase levels are more specific for pancreatic inflammation, while amylase can be elevated in various conditions, including salivary gland issues and gastrointestinal disorders. The normal abdominal ultrasound performed previously is reassuring, as it suggests that there are no structural abnormalities in the abdomen that could explain the elevated enzyme levels.

Regarding the necessity of fasting before blood tests for lipase and amylase, it is generally recommended to fast for at least 8 hours prior to testing. This is to ensure that food does not interfere with the results, as recent meals can potentially elevate amylase levels due to salivary gland stimulation. In your situation, since the child had eaten breakfast shortly before the first blood draw, the elevated levels observed may not accurately reflect the child's baseline enzyme levels.

The subsequent blood draw, taken two hours after dinner, showed a decrease in lipase and a normalization of amylase levels. This suggests that the initial elevation may have been influenced by the timing of the meal. It is essential to interpret these results in conjunction with clinical symptoms and other diagnostic findings.

Given that the child does not exhibit any symptoms of acute or chronic pancreatitis and has had normal imaging studies, the need for further invasive tests such as CT or MRI may not be warranted at this time. Endoscopic ultrasound (EUS) is a more invasive procedure that provides detailed images of the pancreas and surrounding structures, but it is typically reserved for cases where there is a strong suspicion of pancreatic pathology that cannot be confirmed by non-invasive imaging.

In asymptomatic patients, non-invasive imaging techniques like ultrasound or MRI are generally preferred. These methods carry fewer risks and are effective in ruling out significant abnormalities. If the child continues to have elevated lipase levels or develops symptoms suggestive of pancreatitis, then further evaluation, including EUS, may be considered.

In summary, it is advisable to consult with the child's healthcare provider regarding the interpretation of the enzyme levels and the necessity of further testing. Continuous monitoring of the child's condition and enzyme levels, along with a focus on maintaining a healthy lifestyle, including a balanced diet and regular sleep patterns, will be beneficial. If any new symptoms arise or if there are persistent abnormalities in lab results, further investigation may be warranted.

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