Fecal elastase 1, serum amylase and lipase levels in children with cholestasis.
OBJECTIVE
The pancreatic functions of children with cholestatic liver diseases were unclear. Due to anatomic vicinity and common ontogenic origin, hepatobiliary disorders of infancy may also affect pancreatic function. The aim of the study was to evaluate the exocrine pancreatic function and common pancreatic function tests in children with cholestatic disorders.


METHODS
In 40 children with cholestasis, fecal elastase 1 (FE1) concentrations were measured. Serum amylase and lipase values were tested. The diagnoses included 32 patients with extrahepatic cholestasis (biliary atresia (BA) and choledochal cyst), and 8 patients with intrahepatic cholestasis (progressive familial intrahepatic cholestasis and Alagille syndrome). None had renal insufficiency or clinical symptoms/signs of acute pancreatitis.


RESULTS
All the patients had normal FE1 (>200 microg/g). Nineteen percent (7/37) had elevated serum amylase levels (>100 U/l). Thirty-two percent (12/37) had elevated serum lipase levels above the normal (>120 U/l). Seventy-three percent (8/11) of BA patients with bilirubin >2 mg/dl had elevated serum lipase levels compared to 18% (3/17) with bilirubin < or = 2 mg/dl (p = 0.0036). None had detectable pancreatic abnormality on ultrasonography and magnetic resonance images.


CONCLUSIONS
None of the cholestatic children in this study had exocrine pancreatic insufficiency as detected by FE1. Hyperamylasemia and/or hyperlipasemia were frequently found. In children with BA, those with impaired biliary excretion tended to have elevated serum pancreatic enzymes as compared with those who had no jaundice. A decreased hepatic metabolism may be the cause.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Wan-Hsin
WH
Wen
Huey-Ling
HL
Chen
Mei-Hwei
MH
Chang
Yen-Hsuan
YH
Ni
Hsiang-Hung
HH
Shih
Hong-Shiee
HS
Lai
Wen-Ming
WM
Hsu
D016738:Alagille Syndrome / Q000150:complications / Q000201:enzymology / Q000473:pathology; D000681:Amylases / Q000097:blood*; D001656:Biliary Atresia / Q000201:enzymology* / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000150:complications / Q000201:enzymology / Q000473:pathology; D002780:Cholestasis, Intrahepatic / Q000201:enzymology* / Q000235:genetics / Q000473:pathology; D005243:Feces / Q000201:enzymology*; D005260:Female; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood*; D008297:Male; D010196:Pancreatic Elastase / Q000378:metabolism*
D008049:Lipase; D000681:Amylases; D010196:Pancreatic Elastase