Trypsin-like immunoreactivity in the diagnosis of acute pancreatitis.

Elevated serum and urine amylase and serum lipase values are not always diagnostic of an acute pancreatitis, on the account of the extrapancreatic production of these enzymes. A diagnostic improvement can be made by using the CAm/CCr ratio, but this index too is abnormal in some non pancreatic diseases. Since trypsin measurement seems to be more specific in the evaluation of pancreatic condition, serum trypsin-like immunoreactivity has been measured in 28 patients with acute pancreatitis, 95 patients with a wide spectrum of gastroenterological diseases and in 30 patients with severe chronic renal failure. 85 normal subjects were used as controls. Abnormally high serum trypsin-like immunoreactivity (TLI) values were detected in 100% of patients with acute pancreatitis, without any overlap with normal controls. TLI values above the upper normal limit were also found in 70% of patients with severe renal damage, while none of the patients with liver disease, biliary disease, peptic ulcer an inflammatory bowel disease had elevated TLI levels. In 29 patients with hyperamylasemia due to extra-pancreatic diseases serum trypsin-like immunoreactivity was always within the normal range. It is concluded that the determination of serum TLI is a sensitive and reliable tool in the diagnosis of an acute pancreatic inflammation, providing that a severe renal failure is excluded.