Hyperamylasemia in Inflammatory Bowel Disease: Report of a case with literature review

Abstract

SUMMARY
It has been suggested that in patients with inflammatory
bowel disease (IBD) there is subclinical pancreatic
involvement. A 22-year-old male with Crohn’s disease of
the terminal ileum, diagnosed four years earlier was
admitted in our hospital because of persistent asymptomatic
mild hyperamylasemia (serum amylase 135 UI/ml)
during azathioprine treatment. Patient personal history was
unremarkable and there was no evidence of any other
extraintestinal manifestations. Physical examination was
within normal limits and upper gastrointestinal tract
endoscopy with abdominal MRI and MRCP were normal.
During admission it was decided to switch from azathioprine
to methotrexate in order to exclude the possibility of
azathioprine-related idiopathic pancreatitis. However,
serum amylase values did not subsided. An additional
MRCP performed at that time was normal. Subsequent
serum isoamylase determination showed pancreatic isoenzyme
predominance (P-isoenzyme). As patient transaminases
were markedly increased during methotrexate
therapy, it was decided to finally switch the patient again
to azathioprine as the diagnosis of chronic idiopathic
pancreatitis secondary to Crohn’s disease seemed more
probable. On the two-year laboratory follow up the patient
still had mild asymptomatic hyperamylasemia. Differential diagnosis of hyperamylasemia in IBD includes overview of
general and disease specific causes of hyperamylasemia,
as well as laboratory investigative methods on amylase
typing and subtyping. In the absence of specific indications
this hyperamylasemia requires no further investigation.
Key words: hyperamylasemia, Crohn’s disease, ulcerative
colitits, isoamylases.