[Is the identification of acute biliary and alcoholic pancreatitis by early pancreatic enzyme assay possible?].
Early and appropriate treatment of acute pancreatitis (AP) depends on early causal diagnosis. Published studies have shown favourable results following sphincterotomy performed within the 72 hours of onset of severe gallstone-associated AP. Among the various bio-clinical indices, the lipase/amylase (L/A) ratio, computed within 72 hours after onset, has been shown to discriminate between alcoholic and non alcoholic AP. Our study evaluates the data of biochemical disorders in 51 patients presenting with an episode of AP; these patients were divided into 3 groups: A: alcoholic AP, n = 15; B: biliary AP, n = 25; and C: post-ERCP AP, n = 11. These 3 groups were similar with respect to clinical severity of AP and CT scan. The time delays between onset of the symptoms and the biochemical assay were 1.9 +/- 0.3, 1.9 +/- 0.2 and 0.6 +/- 0.3 d (P < 0.01). AST, ALT, bilirubin, GGT and alkaline phosphatase were significantly (P < 0.05) greater in group B. Blamey's score was 0.5 +/- 0.2, 2.8 +/- 0.2 and 2.5 +/- 0.4 in groups A, B and C respectively. Serum amylase, serum lipase and L/A ratio were identical in groups A and B. The decrease in serum amylase after 48 hours was more important only in group B (56 +/- 8, 80 +/- 4, 47 +/- 3% respectively in groups A, B and C). L/A ratio was significantly greater in group C when compared with group A and B (1.7 +/- 0.4, 1.5 +/- 0.2 and 2.2 +/- 0.3 in groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Heresbach
D
D
Service d'Hépato-Gastroentérologie, CHRU Pontchaillou, Rennes.
Boutroux
D
D
Bretagne
J F
JF
Raoul
J L
JL
Siproudhis
L
L
Lebert
P
P
Nicol
M
M
Gosselin
M
M
D000208:Acute Disease; D000410:Alanine Transaminase / Q000097:blood; D000681:Amylases / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002769:Cholelithiasis / Q000150:complications*; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood*; D008111:Liver Function Tests; D008297:Male; D010195:Pancreatitis / Q000097:blood / Q000201:enzymology* / Q000209:etiology
D000431:Ethanol; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D008049:Lipase; D000681:Amylases; D001663:Bilirubin