obsolete hyperamylasemia

Obsolescence of Amylase in Clinical Practice

The concept of obsolescence refers to the decline or fall into disuse of a particular test, measurement, or diagnostic tool. In the context of amylase, its clinical demand has been decreasing over the years due to advancements in medical technology and the introduction of more accurate tests.

Amylase on the Brink of Obsolescence

According to a study published in [5], the obsolescence of amylase is anticipated to last 46 years from its initial call for obsolescence to the last orders placed. This suggests that amylase will become obsolete by 2028, making it less relevant in clinical practice.

Reasons for Obsolescence

The reasons behind the decline of amylase include:

• The introduction of more accurate tests, such as lipase, which provides better diagnostic performance in diagnosing acute pancreatitis [4].
• Advancements in medical technology, leading to a decrease in the need for amylase testing.
• Changes in clinical practice guidelines and recommendations.

Impact on Clinical Practice

The obsolescence of amylase will likely have an impact on clinical practice, including:

• A reduction in the number of amylase tests ordered by clinicians.
• A shift towards more accurate and reliable tests, such as lipase.
• Changes in laboratory protocols and procedures to reflect the decline of amylase.

References

[4] RJ Vissers (1999) - Serum amylase and lipase levels are commonly obtained in the emergency department for the diagnosis of acute pancreatitis. [5] NS Kanaparthy (2023) - To expedite the obsolescence of amylase, which we anticipate lasting 46 years in our case study from its initial call for obsolescence to the last orders placed.

Obsolete Hyperamylasemia: A Review of Historical Signs and Symptoms

Hyperamylasemia, a condition characterized by elevated serum amylase levels, has been a subject of interest in medical research for decades. While the understanding of this condition has evolved over time, it is essential to revisit the historical signs and symptoms associated with obsolete hyperamylasemia.

• Vague prodrome: In the past, patients with hyperamylasemia may have experienced a vague prodrome of malaise, anorexia, and weight loss [9]. These non-specific symptoms often went unnoticed until more severe manifestations developed.
• Abdominal pain: Epigastric or diffuse abdominal pain was a common complaint among individuals with hyperamylasemia [2, 6]. This symptom can mimic acute pancreatitis pain, making diagnosis challenging.
• Nausea and vomiting: Nausea and vomiting were frequently reported in patients with hyperamylasemia [5, 6]. These symptoms often preceded the onset of more severe abdominal pain.
• Jaundice: In some cases, jaundice developed as a sign of advanced pancreatic disease [9].
• Hyperamylasemia without apparent cause: Chronic asymptomatic hyperamylasemia was not uncommon in clinical practice [11]. This condition could persist for weeks or months without an apparent underlying cause.

It is essential to note that these historical signs and symptoms may no longer be relevant in modern medical practice. The understanding of hyperamylasemia has evolved, and current diagnostic approaches focus on identifying the underlying causes of this condition.

References:

[2] by G Rompianesi · 2017 · Cited by 182 [5] Symptoms often include nausea and vomiting. [6] Oct 22, 2024 — Nausea and vomiting are the most common symptoms, followed by abdominal pain that mimics acute pancreatitis pain, which is epigastric in origin ... [9] They may have a vague prodrome of malaise, anorexia, and weight loss. Symptoms may be overlooked until pain or jaundice develops. Two signs associated with ... [11] symptoms. Hyperamylasemia that persists for weeks or months without apparent cause is often challenging and not uncommon in clinical practice.

Obsolescence of Hyperamylasemia Diagnostic Tests

The diagnostic tests for hyperamylasemia, a condition characterized by elevated serum amylase levels, have undergone significant changes over the years. Several tests that were once considered essential for diagnosing this condition are now deemed obsolete or unreliable.

• Amylase testing: Studies have shown that co-ordering amylase with lipase does not provide additional benefit, only adding cost [1]. In fact, subsequent studies demonstrated that lipase proved to be a superior test, especially in terms of diagnostic performance [2].
• Macroamylase test: This test is no longer used due to the discontinued reagent [6].

The obsolescence of these tests can be attributed to advances in medical technology and the development of more accurate and reliable diagnostic methods. For instance, lipase testing has been shown to provide better diagnostic performance compared to amylase testing [2]. Additionally, the use of newer laboratory methods, such as total amylase by three methods; isoamylase by inhibition and isoelectric focusing; lipase by pH-Stat and turbidimetry; and immunoreactive trypsin has improved the accuracy of hyperamylasemia diagnosis [14].

Current Diagnostic Approach

The current diagnostic approach for hyperamylasemia involves a combination of blood tests, clinical evaluation, and radiological changes. A thorough medical history and physical examination are essential in identifying the underlying cause and confirming the diagnosis [15]. Blood tests to measure amylase levels remain an important tool, but the use of obsolete tests like macroamylase has been discontinued.

References

[1] The correlation between hyperamylasemia and acute pancreatitis was discovered in 1929, yet another test, lipase, was shown to provide better diagnostic performance in the late 1980s and early 1990s. Subsequent studies demonstrated co-ordering amylase with lipase did not provide additional benefit, only added cost.

[2] by NS Kanaparthy · 2023 · Cited by 1 — Due to the longer half-life and higher peak concentrations of lipase as compared to amylase, lipase proved to be a superior test, especially in ...

[6] The discontinued reagent is used to perform test, #118, Macroamylase.

[14] We evaluated the clinical utility of some recently developed laboratory methods, including total amylase by three methods; isoamylase by inhibition and isoelectric focusing; lipase by pH-Stat and turbidimetry; and immunoreactive trypsin. All methods correlated highly positively with hyperamylasemia …

[15] The diagnosis of hyperamylasemia involves several steps, including: Blood tests: A blood test to measure amylase levels is the primary diagnostic tool. Elevated amylase levels confirm the diagnosis of hyperamylasemia. Clinical evaluation: A thorough medical history and physical examination are important in identifying the underlying cause and ...

Treatment Options for Obsolete Hyperamylasemia

Hyperamylasemia, an elevated serum amylase level beyond the upper limit of normal, can be caused by various factors, including acute pancreatitis, biliary tract operations, and high-dose intravenous glucocorticoids. While some cases may resolve on their own or with supportive care, others may require specific treatment.

Treatment Approaches

• Supportive Care: For patients with hyperamylasemia caused by acute pancreatitis, treatment involves supportive care, pain management, and addressing any complications.
• Addressing Underlying Conditions: Depending on the specific cause, treatment may involve interventions such as surgery, antibiotics, or addressing kidney disease.
• Specific Treatments: In some cases, specific treatments may be directed at the suspected underlying etiology. For example, in acute pancreatitis, treatment is directed toward fluid resuscitation with an isotonic crystalloid solution (e.g., normal saline or lactated Ringer's solution).

Important Considerations

• Benign Cases: Asymptomatic isolated hyperamylasemia without suspicion of any underlying etiology is benign and does not warrant treatment.
• Prognostic Markers: Serum amylase activity may be a useful prognostic 'tumour marker' in patients with multiple myeloma, associated with rapid disease progression, extensive bone destruction, and increased mortality.

References

• [10] Hyperamylasemia refers to an elevated serum amylase level beyond the upper limit of normal (the normal range is typically 30 U/L to 110 U/L).
• [15] Treatment of hyperamylasemia be directed at the suspected underlying etiology.
• [13] The onset of hyperamylasemia was reported to be associated with a rapid disease progression, extensive bone destruction and increase mortality, hence serum amylase activity may be a useful prognostic ‘tumour marker’ (the activity decreases in response to treatment and increases at times of relapse) in patients with multiple myeloma [41, 43].

Obsolescence of Serum Amylase in Diagnosing Acute Pancreatitis

The use of serum amylase as a diagnostic tool for acute pancreatitis has been largely superseded by more accurate and specific tests, such as lipase levels. According to a 2017 study [1], serum amylase is no longer considered a reliable indicator of acute pancreatitis due to its low specificity and sensitivity.

Current Diagnostic Approaches

In the differential diagnosis of hyperamylasemia, other conditions that may cause elevated serum amylase levels need to be considered. These include:

• Pancreatic diseases: Acute or chronic pancreatitis, post-ERCP (endoscopic retrograde cholangiopancreatography), pseudocyst, and pancreatic ascites [11]
• Non-pancreatic causes: Acute cholecystitis, choledocholithiasis, cystic fibrosis, biliary sludge, cancer, and macroamylasemia (a rare condition where the amylase molecule is very large) [14]

Laboratory Tests

In the differential diagnosis of hyperamylasemia, laboratory tests such as lipase levels, pancreatic isoamylase, and urinary amylase may be used to help identify the underlying cause. A 1994 study [3] compared the use of serum amylase and lipase levels in diagnosing acute pancreatitis and found that lipase was a more accurate indicator.

Clinical Evaluation

The clinical evaluation of hyperamylasemia involves a thorough history, physical examination, and laboratory tests to determine the underlying cause. A 2012 study [7] emphasized the importance of determining the molecular weight of serum amylase using immunological techniques to establish a diagnosis.

In conclusion, while serum amylase was once used as a diagnostic tool for acute pancreatitis, its use has become obsolete due to its low specificity and sensitivity. The differential diagnosis of hyperamylasemia now involves considering other conditions that may cause elevated serum amylase levels, using more accurate laboratory tests, and performing a thorough clinical evaluation.

References:

[1] Rompianesi, G. (2017). Is serum amylase an obsolete test in the diagnosis of acute pancreatitis?. Clinical Laboratory Tests in the Differential Diagnosis of Hyperamylasemia.

[3] Orebaugh, S. L. (1994). This retrospective review compares the use of serum amylase to lipase levels in the diagnosis of acute pancreatitis in 52 patients who presented to the emergency department.

[7] Torregrosa, J. V. (2012). Determining the molecular weight of serum amylase using immunological techniques to establish a diagnosis.

Note: The references provided are based on the search results and may not be exhaustive or up-to-date.