Enzyme Biomarkers: Amylase

Optimal Takeaways

Amylase, an enzyme produced primarily in the salivary glands and pancreas, is designed to break down starchy carbohydrates. Elevations in the blood may be caused by pancreatitis, other gastrointestinal insults, or reduced kidney function and should be investigated. Alcohol, medications, and acidosis can also increase serum amylase. Low levels in the blood may be seen in metabolic disorders such as obesity, diabetes, metabolic syndrome, and fatty liver and pancreas diseases.

Standard Range: 21 - 103 U/L

The ODX Range: 40 - 86 U/L              

Low serum amylase may be observed in chronic pancreatitis (Oh 2017), obesity, blood glucose dysregulation, metabolic syndrome, diabetes, and non-alcoholic fatty liver and fatty pancreas disease (Ko 2020). Medications that can decrease amylase include glucose, oxalates, and citrates (Pagana 2021).

High serum amylase can be associated with acute pancreatitis, acute cholecystitis, perforated ulcer, duodenal obstruction, necrotic bowel, rheumatoid disease, diabetic ketoacidosis, and kidney failure. Medications that may increase amylase include aspirin, narcotic analgesics, corticosteroids, glucocorticoids, loop diuretics, and oral contraceptives. Alcohol ingestion can also cause increased serum amylase (Pagana 2021).

Elevated amylase may also be seen in macroamylasemia, pancreatic obstruction, pancreatic cancer, intestinal perforation or compromise, cystic fibrosis, hepatitis, cirrhosis, acidosis, peritonitis, burns, head injury, salivary disease, and infectious disease (Ismail 2017). Elevated amylase in organophosphate pesticide poisoning may be an indicator of more severe dysfunction and increased mortality (Raveendra 2021).

Overview

Amylase is a digestive enzyme that breaks down dietary starch into glucose. It is produced primarily by the pancreas and salivary glands and can become elevated in the blood in the event of acute pancreatitis, pancreatic obstruction, or parotiditis (mumps). Levels may also increase during perforation of the bowel, penetrating peptic ulcer, or duodenal obstruction. Amylase in circulation can be quickly cleared by the kidney and return to normal within 48-72 hours of an acute event (Pagana 2021).

An elevation of serum amylase above 90 U/L was associated with respiratory failure, need for intubation, and mortality in acute organophosphorus pesticide poisoning (Raveendra 2021).

A low serum amylase below 40 U/L may indicate chronic pancreatitis as tissue damage progresses and function is compromised (Oh 2017). Low serum amylase is also observed in metabolic disorders including blood sugar dysregulation, non-alcoholic fatty liver disease, and non-alcoholic fatty pancreas disease. A meta-analysis of 20 studies demonstrated that significantly lower serum amylase levels are seen in obesity, metabolic syndrome, and type 2 diabetes when compared to healthy individuals (Ko 2020).

References

Ismail, Ola Z, and Vipin Bhayana. “Lipase or amylase for the diagnosis of acute pancreatitis?.” Clinical biochemistry vol. 50,18 (2017): 1275-1280. doi:10.1016/j.clinbiochem.2017.07.003

Ko, Juyeon et al. “Low serum amylase, lipase, and trypsin as biomarkers of metabolic disorders: A systematic review and meta-analysis.” Diabetes research and clinical practice vol. 159 (2020): 107974. doi:10.1016/j.diabres.2019.107974

Oh, Hyoung-Chul et al. “Low Serum Pancreatic Amylase and Lipase Values Are Simple and Useful Predictors to Diagnose Chronic Pancreatitis.” Gut and liver vol. 11,6 (2017): 878-883. doi:10.5009/gnl17066

Pagana, Kathleen Deska, et al. Mosby's Diagnostic and Laboratory Test Reference. 15th ed., Mosby, 2021.

Raveendra, K. R., and C. N. Mohan. "A study of serum amylase as a probable prognostic marker in acute organophosphorus poisoning." APIK Journal of Internal Medicine 9.2 (2021): 94.