Chronic asymptomatic hyperamylasemia unrelated to pancreatic disease

BACKGROUND Almost all patients presenting with chronic hyperamylasemia undergo an expensive, long, difficult and often repeated diagnostic workup even if this occurrence is not associated with symptoms or with known pancreatotoxic factors. This is in relationship with the poor knowledge that, beside hyperenzymemia secondary to pancreatic diseases and systemic illnesses, various non-pathological forms of chronic hyperamylasemia can occur in clinical practice.
AIM OF THE STUDY This study was addressed to assess the clinical characteristics of patients presenting with chronic hyperamylasemia unrelated to pancreatic diseases (CHUPD).
PATIENTS AND METHODS Data of all patients with CHUPD were retrospectively reviewed (June 1997-March 2007). Forty patients were included in the study; median follow- up was 33 months (range 3-84 months). CHUPD was secondary to: a) chronic benign pancreatic hyperamylasemia, 16 patients (40%); b) macroamylasemia, 15 patients (37.5%); c) salivary hyperamylasemia, 9 patients (22.5%). Gilbert's syndrome was present in 13 patients (32.5%; 8 with macroamylasemia) and hyperdyslipidemia in 8 patients (20%; 5 with chronic benign pancreatic hyperamylasemia). Diagnostic exams (all in the normal range) performed before our observation were: Ca19-9 serum level in 37/40 (92.5%), ultrasonography and computed tomography-scan in all patients, endoscopic retrograde cholangiopancreatography in 21/40 (52.5%), abdominal magnetic resonance in 14/40 (35%). Previous diagnosis in these asymptomatic subjects were: chronic pancreatitis in 26 cases (65%); recurrent pancreatitis in 10 cases (25%); the remaining 4 patients (10%) were addressed without a specific diagnosis.
CONCLUSIONS In clinical practice, the occurrence of an unexplained chronic hyperamylasemia very often allows to an unappropriate diagnostic workup due to the poor familiarity with CHUPD conditions.