Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Relation of the magnitude of blood enzyme elevation to severity of exocrine pancreatic disease


Blood levels of lipase, amylase, and trypsin occurring spontaneously and after pancreatic stimulation with secretin-pancreozymin (S-P) or morphine-Prostigmin (M-P) were measured in 200 normal subjects and patients with various types and stages of exocrine pancreatic disease. Maximum enzyme elevations occurred in two opposite conditions: after M-P stimulation in normal subjects, and spontaneously in patients with moderate acute pancreatitis. The lowest elevations occurred also in two opposite conditions: after S-P stimulation in patients with minimal disease, and in patients with extensive disease. Intermediate elevations occurred in patients with either mild or severe pancreatitis. The relation between magnitude of blood enzyme elevation and severity of pancreatic disease was thus found to be a combination of direct and inverse correlations; two possible interpretations always exist for the same enzyme value and must be clarified in terms of the type of stimulus, whether hormonal, pharmacologic, or inflammatory. This relationship is depicted graphically by a double-limb response curve which embodies the entire spectrum of health and disease and can be applied to stimulation tests of pancreatic function as well as to spontaneous enzyme values in disease. Stages of disease can be quantified by the degree of elevation of blood enzymes.

This is a preview of subscription content, log in to check access.


  1. 1.

    Brooks FP: Current concepts: testing pancreatic function. N Engl J Med 286:300–303, 1972

  2. 2.

    Bockus HL, Lopusniak MS, Tachdjian V: Diagnostic procedures in the study of pancreatic disorders, Gastroenterology. Chap 123. Vol III. Edited by HL Bockus. Second edition. Philadelphia, WB Saunders Co, 1965, pp 893–917

  3. 3.

    Kowlessar OD: Diseases of the pancreas, Cecil-Loeb Textbook of Medicine. Edited by PB Beeson, W McDermott. Thirteenth edition. Philadelphia, WB Saunders Co, 1971, pp 1312–1327

  4. 4.

    Dreiling DA, Janowitz HD, Perrier CV: Pancreatic Inflammatory Disease: A Physiologic Approach. New York, Harper & Row, 1964, pp 117–124

  5. 5.

    Howard JM, Jordan GL Jr: Surgical Diseases of the Pancreas. Philadelphia, JB Lippincott Co, 1960, pp 124–142

  6. 6.

    Spiro HM: Clinical Gastroenterology. New York, The MacMillan Co, 1970, pp 791–816

  7. 7.

    Adams JT, Libertino JA, Schwartz SI: Significance of an elevated serum amylase. Surgery 63:877–884, 1968

  8. 8.

    Gibbs GE, Ivy AC: Early histological changes following obstruction of pancreatic ducts in dogs: correlation with serum amylase. Proc Soc Exp Biol Med 77:251–254, 1951

  9. 9.

    Hall ER, Howard JM, Jordan GL Jr, Witt R: A study of serum amylase concentration in patients with acute cholecystitis. Ann Surg 143:517–519, 1956

  10. 10.

    Bogoch AJ, Roth JLA, Bockus HL: The effects of morphine on serum amylase and lipase. Gastroenterology 26:697–708, 1954

  11. 11.

    Wapshaw H: The pancreatic side effects of morphine. Br Med J 1:373–375, 1953

  12. 12.

    Abruzzo JL, Homa M, Houck JC, Coffey RJ: Significance of the serum amylase determination. Ann Surg 147:921–930, 1958

  13. 13.

    Bernard HR, Criscione JR, Moyer CA: The pathologic significance of the serum amylase concentration. Arch Surg 79:311–316, 1959

  14. 14.

    Elliott DW, Williams RD: A re-evaluation of serum amylase determinations. Arch Surg 83:130–136, 1961

  15. 15.

    Trapnell JE, Anderson MC: Role of early laparotomy in acute pancreatitis. Ann Surg 165:49–55, 1967

  16. 16.

    Grossman MI: Experimental pancreatitis. Arch Intern Med 96:298–307, 1955

  17. 17.

    Berk JE: Diagnostic features of pancreatic disease. JAMA 159:1079–1085, 1955

  18. 18

    MacNab I: Subacute pancreatitis. Br Med J 1:568–571, 1949

  19. 19.

    Sun DCH, Shay H: Pancreozymin-secretion test: the combined study of serum enzymes and duodenal contents in the diagnosis of pancreatic disease. Gastroenterology 38:570–581, 1960

  20. 20. a)

    Tietz NW, Borden T, Stepelton JD: Improved method for determination of lipase in serum. Am J Clin Pathol 31:148–154, 1959.

  21. 20. b)

    Tietz NW, Fiereck EA: A specific method for serum lipase determination. Clin Chim Acta 13:352–358, 1966

  22. 21.

    Bray WE: Clinical Laboratory Methods. Fifth edition. St. Louis, CV Mosby Co, 1957, p 349

  23. 22.

    Gullick HD: Differentiation of trypsin-like enzymes in human plasma. Clin Chem 18:1385–1394, 1972

  24. 23.

    Gullick HD: Increased plasma proteolytic activity due to arginine amidase in patients with pancreatitis. N Engl J Med 268:851–857, 1963

  25. 24.

    Gullick HD: Trypsin activity in blood and other body fluids, Technical Manual. Workshop on Clinical Enzymology, Commission on Contiuing Education, American Society of Clinical Pathologists, 1964, pp 193–207

  26. 25.

    Nardi GL: Serum trypsin determination in pancreatic disease. J Lab Clin Med 52:66–69, 1958

  27. 26.

    Nardi GL: Specific polypeptide substrates in enzymatic determination of pancreatic disease. Surgery 46:30–37, 1959

  28. 27.

    Gullick HD: Plasma amidase and amylase activity in patients undergoing operation. Surgery 57:230–240, 1965

  29. 28.

    Gullick HD, Schauble MK: SD unit system for standardized reporting and interpretation of laboratory data. Am J Clin Pathol 57:517–525, 1972

Download references

Author information

Correspondence to Dr. Herbert D. Gullick MD.

Additional information

Studies supported by the General Medical Research Service, Veterans Administration.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gullick, H.D. Relation of the magnitude of blood enzyme elevation to severity of exocrine pancreatic disease. Digest Dis Sci 18, 375–383 (1973). https://doi.org/10.1007/BF01071986

Download citation


  • Enzyme
  • Lipase
  • Pancreatitis
  • Amylase
  • Acute Pancreatitis