title: Unexplained elevated serum pancreatic enzymes: a reason to suspect celiac disease.
abstract: OBJECTIVE
  The frequency of elevated serum pancreatic enzymes in patients with celiac disease (CD) is unknown. The aim of this study was to evaluate the serum levels of pancreatic enzymes in CD patients.
  
  
  METHODS
  Serum pancreatic isoamylase and lipase levels were assayed in 90 adult and 112 pediatric consecutive CD patients at diagnosis and after 12 months of gluten-free diet (GFD). Serum elastase and trypsin levels were assayed in a subgroup of adult CD patients. Pancreatic ultrasonography was also performed.
  
  
  RESULTS
  Twenty-six adult (29%) and 29 pediatric (26%) CD patients exhibited elevated values of serum pancreatic amylase and/or lipase; trypsin was elevated in 69% and elastase in 19%. The frequency of elevated serum pancreatic enzymes observed was identical in the patients with "typical" and "atypical" CD symptoms and in the asymptomatic patients. Most of the elevated values were lower than 2-fold the threshold limits. Elevated pancreatic enzymes were not associated with alcohol consumption, drug use, presence of abdominal pain, or diabetes mellitus. Abdominal ultrasound scan showed no abnormal findings in the pancreatic region in any of the CD patients. After 12 months of GFD, pancreatic amylase was elevated in 3 cases and lipase in 2 cases; these patients had not strictly adhered to the GFD.
  
  
  CONCLUSIONS
  We demonstrated a frequency of about 25% of elevated pancreatic enzymes values in CD patients, including subjects without gastrointestinal manifestations and apparently asymptomatic subjects. The finding of elevated serum amylase or lipase level, in the absence of signs of pancreatic disease, would appear to suggest a need to screen for celiac disease.
authors.affiliation: Internal Medicine, University Hospital of Palermo, Palermo, Italy. acarroccio@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Carroccio
authors.forename: Lidia
authors.initials: L
authors.lastname: Di Prima
authors.forename: Calogero
authors.initials: C
authors.lastname: Scalici
authors.forename: Maurizio
authors.initials: M
authors.lastname: Soresi
authors.forename: Angelo B
authors.initials: AB
authors.lastname: Cefalù
authors.forename: Davide
authors.initials: D
authors.lastname: Noto
authors.forename: Maurizio R
authors.initials: MR
authors.lastname: Averna
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montalto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iacono
mesh_terms: D000293:Adolescent; D000328:Adult; D000681:Amylases / Q000097:blood*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000178:diet therapy / Q000201:enzymology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005983:Glutens; D006801:Humans; D007517:Isoamylase / Q000097:blood*; D008049:Lipase / Q000097:blood*; D008297:Male; D010196:Pancreatic Elastase / Q000097:blood; D014357:Trypsin / Q000097:blood
chemical_list: D005983:Glutens; D008049:Lipase; D000681:Amylases; D007517:Isoamylase; D010196:Pancreatic Elastase; D014357:Trypsin