Correlation of pancreatic enzyme levels with the patient's recovery from acute edematous pancreatitis.

Levels of total amylase, pancreatic isoamylase, lipase and immunoreactive trypsin were measured in 27 consecutive patients with noncomplicated (methemalbumin negative, no pseudocysts on ultrasound) acute pancreatitis during the acute, subacute, and recovery phases. At the beginning of the recovery phase (no pain, start of oral food intake), amylase and pancreatic isoamylase were below normal, whereas lipase (12% of the patients) and especially trypsin (52% of the patients) were still three times above the upper limit of normal. None of the patients showed a relapse of pain at the time of oral food intake. The conclusion is that amylase and pancreatic isoamylase reflect more accurately the patient's recovery pattern in acute pancreatitis than the other enzymes. Trypsin, however, may be significant in cases of delayed diagnosis. Thus, the decision to start oral food intake should be based on the patient's clinical state rather than on pancreatic enzyme levels.