Lipase is an enzyme that helps break down fats in the body. Its levels can be measured with a serum lipase blood test. Small amounts of lipase in the blood are normal. When levels get too high, it suggests the presence of a health problem, particularly related to the pancreas, such as acute pancreatitis, which is responsible for 275,000 hospitalizations in the United States every year.
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Understanding Lipase
Lipase collectively refers to the group of enzymes that facilitate the breakdown of triglycerides into their building blocks – fatty acids and glycerol. Triglycerides are the most common form of fat (lipid) in the body, and their primary role is to serve as an energy reserve. Triglycerides are transported through the bloodstream by molecules called lipoproteins and are either used by cells for energy or stored in fat tissue.
The pancreas makes most of the body's lipase, but it is also found in other tissues and named accordingly (26):
- Pancreatic lipase is made by the pancreas and secreted into the small intestine to assist the digestion of dietary triglycerides.
- Hepatic lipase in the liver degrades triglycerides packed in intermediate-density lipoproteins (IDL).
- Hormone-sensitive lipases break down triglycerides that have been stored within fat tissue.
- Lipoprotein lipase (LPL) in the blood vessels breaks down triglycerides carried in circulation by lipoproteins.
Lipase Blood Test
A lipase blood test measures the amount of lipase in your blood and is used as a marker of pancreatic health and function. Your doctor may order this test if you complain of the following symptoms:
- Upper abdominal pain that travels to the back
- Fever
- Nausea and vomiting
- Fast heartbeat
- Diarrhea
- Greasy, foul-smelling stools
- Weight loss
This test requires a blood draw, in which a healthcare provider will collect a sample of blood by inserting a needle into a vein, typically in an arm. Your provider may have you prepare for the test beforehand by fasting (no food or drink except water) for 8-12 hours and discontinuing certain medications that can falsely elevate lab results (discussed in more detail below).
Lipase levels are measured in units per liter (U/L). In general, normal values range from 0 to 160 U/L, but this may vary slightly depending on age, gender, and laboratory. The following table outlines normal lipase reference ranges that are more specific to age and gender.
High Lipase Levels
A high lipase level is any value that exceeds the upper limit of the normal reference range.
Lipase is a specific and sensitive test for diagnosing acute pancreatitis, a sudden and reversible inflammation of the pancreas most often caused by gallstones or chronic alcohol use. During acute pancreatic inflammatory flare-ups, lipase begins to increase within 3-6 hours of symptom onset, peaks at 24 hours, and remains elevated for 7-14 days.
In chronic pancreatitis, which is progressive and irreversible inflammation of the pancreas, lipase may be normal or only mildly elevated.
According to one study, more than 25% of patients presenting to the emergency department with elevated lipase have a condition other than pancreatitis. Other causes of high lipase include:
- Alcohol use disorder
- Bowel obstruction
- Celiac disease
- Cholecystitis (gallbladder inflammation)
- Diabetic ketoacidosis (DKA)
- Gallstones
- High triglycerides (hypertriglyceridemia)
- Infections, including chronic hepatitis C, HIV, and cytomegalovirus (CMV)
- Inflammatory bowel disease (IBD)
- Kidney disease
- Liver disease
- Peptic ulcer disease (PUD)
- Trauma
Some medications can also increase lipase levels. These include:
- Antibiotics
- Birth control pills
- Cholesterol-lowering medications
- Cholinergic drugs, which are used to treat conditions related to involuntary cognitive, muscular, blood vessel, and glandular function
- Diuretics
- Pain medications, such as morphine and codeine
Additional Testing and Biomarkers
On its own, elevated serum lipase is not sufficient to make a diagnosis of acute pancreatitis. According to the Revised Atlanta Classification, acute pancreatitis can be diagnosed when at least two of the three criteria are met:
- The patient presents with abdominal pain that is consistent with pancreatitis
- Serum amylase or lipase levels are at least three times the upper limit of normal
- Characteristic findings are visualized on imaging CT, MRI, or transabdominal ultrasound imaging tests
Lipase is commonly co-ordered with amylase, another pancreatic enzyme that breaks down complex carbohydrates into small sugars. During acute pancreatitis, serum amylase rises within a few hours; however, compared to lipase, it returns to normal more quickly. Upon hospital admission, as many as one-fifth of patients with acute pancreatitis have normal serum amylase levels. (31)
Other tests help to narrow the list of possible causes of elevated lipase levels. These may include:
- Complete blood count (CBC) to screen for signs of infection
- Comprehensive metabolic panel (CMP) to assess blood sugar, kidney function, and liver/gallbladder health
- Lipid panel to measure triglycerides
- Celiac antibodies to screen for celiac disease
- Fecal calprotectin to quantify intestinal inflammation
Treatment and Management
Treatment strategies for elevated lipase levels focus on addressing the specific cause or contributing factors.
Most patients who are diagnosed with acute pancreatitis are treated in the hospital, where they are monitored for infection and other complications. Treatment includes bowel rest, rehydration with intravenous fluids, and pain management. (27)
Patients will also be treated for the underlying cause of pancreatitis, such as gallstones and alcohol use disorder. Gallstones may need to be removed surgically or through a procedure called endoscopic retrograde cholangiopancreatography (ERCP). (27, 33)
General recommendations that can help treat and prevent conditions that lead to high lipase levels include:
- Eat a healthy, anti-inflammatory diet that limits processed foods, added sugars, and unhealthy fats
- Stay well hydrated
- Drink alcohol in moderation or eliminate it completely
- Exercise regularly
Risks and Complications
Lipase levels greater than three times the upper limit of normal are strongly indicative of pancreatitis. In addition, a lipase-to-amylase ratio greater than 4-5 strongly supports alcohol-related pancreatitis. (27)
The risks associated with untreated high lipase depend on what's causing the elevation. For example, untreated pancreatitis can cause serious complications, including infection, kidney failure, malnutrition, diabetes, and pancreatic cancer.
For this reason, patients with elevated lipase levels need to seek medical care, follow their doctor's treatment recommendations, and follow up appropriately.
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Key Takeaways
- The lipase blood test is a relatively noninvasive laboratory test that can help doctors diagnose pancreatitis and other medical conditions affecting the pancreas.
- Elevated lipase refers to higher-than-normal levels of the enzyme in the blood. Lipase elevations at least three times the upper limit of normal are suggestive of acute pancreatitis.
- Patients who have elevated lipase levels require medical attention. Doctors should order complementary diagnostic tests and imaging to identify and treat the underlying cause appropriately.
- Treating medical conditions causing high lipase levels in their early stages prevents them from becoming severe and causing consequential health complications.
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