Pancreatic amylase test (P-AMYL): what the result means

Amylase is an enzyme that breaks carbohydrates (starch) down into simpler sugars. Most of the amylase in the body is produced by the pancreas and the salivary glands, so the amylase measured in blood is in fact a mixture from two sources. In Lithuanian laboratories pancreatic amylase (P-AMYL) is a separate test — only the amylase isoenzyme specific to the pancreas is measured, which is why its reference range is lower than that of total alpha amylase (AMYL). Both tests are used when pancreatic disease is suspected, primarily acute pancreatitis, and they are often done together, so the result has to be compared against the interval stated on your own result sheet.

In a healthy person, part of the amylase naturally reaches the blood from the pancreas and the salivary glands. But when pancreatic tissue is damaged or its ducts become blocked, far more of the enzyme enters the bloodstream, and its concentration rises sharply within a few hours of the symptoms starting. The amylase test is done from blood, less often from urine. The result is always assessed together with clinical symptoms and other tests, because an isolated change in amylase without symptoms rarely has any meaning of its own.

• When there is severe pain in the upper abdomen, which may spread to the back
• When the abdominal pain comes with nausea, vomiting, loss of appetite or fever
• When acute or chronic inflammation of the pancreas (pancreatitis) is suspected
• To monitor already diagnosed pancreatitis or a pancreatic pseudocyst during treatment
• When a blockage of the pancreatic or bile ducts is suspected
• When stools are fatty and foul-smelling alongside other digestive problems

A raised pancreatic amylase is most often linked to acute inflammation of the pancreas (pancreatitis) or to a blockage of the pancreatic duct. Pancreatic amylase is more specific than total alpha amylase: Affidea states that its concentration in blood rises only when there are pathological processes in the pancreas and the peritoneum, while inflammation of the salivary glands and other conditions outside the pancreas raise total alpha amylase more. The value is always discussed together with the clinical symptoms.

• Acute inflammation of the pancreas (pancreatitis)
• A blockage of the pancreatic or bile duct
• A pancreatic tumour or another disease of the pancreas
• Damage to the peritoneum, bowel obstruction or perforation

Symptoms that can accompany a raised result

• Severe pain in the upper abdomen, which may spread to the back
• Loss of appetite
• Nausea and vomiting
• Fever
• A faster heartbeat
• Jaundice
• Fatty, foul-smelling stools

What to discuss with a doctor

• A lipase test — it is often assessed together with amylase, because it is more specific for pancreatic disease
• Imaging (ultrasound, CT) to check for a blocked duct or damage to the pancreas
• Liver and bile duct markers, if a problem with the biliary tract is suspected
• How long the symptoms have lasted and how severe they are — that is what determines whether urgent care is needed

A lowered amylase occurs less often than a raised one and is most often linked to chronic damage to pancreatic tissue, when the pancreas produces less of the enzyme. Other possible causes are liver disease, heart failure, tumours of the digestive tract, a bone fracture or pregnancy. It is always worth discussing the value with a doctor together with the other markers.

• Chronic inflammation of the pancreas with scarring of the tissue, which reduces enzyme production
• Heart failure
• Tumours of the digestive tract
• A bone fracture
• Pregnancy and pre-eclampsia

What is looked at when the value is low

• Assessment of pancreatic function over a longer period, if chronic pancreatitis is suspected
• Liver markers, if liver disease is suspected
• The general clinical condition and other symptoms, which help establish the cause
• When to repeat the test in order to assess the change

Tests read alongside amylase

Amylase is often assessed together with lipase, which is considered the more specific marker of pancreatic disease, because far less of it is produced by other organs. Total alpha amylase (AMYL) is a separate test with a different reference interval, and it is also produced by the salivary glands. If a problem with the biliary tract is suspected, liver and bile duct markers are looked at as well — ALT, AST, GGT and bilirubin. The result is always assessed together with clinical symptoms and other tests, and how to read blood test results explains what the figures on a result sheet mean.