Variations in time of serum pancreatic enzyme and clinical course of the disease.

Thirty-four patients with chronic calcified pancreatitis were evaluated clinically and biochemically (at a time when painful relapses were not present) every 9 mo for 3 yr; 25 of them were also studied at 4 and 9 yr. Serum elastase-1, trypsin, lipase, and amylase in thè same sera were mea-sured at each visit; levels on entry and variations during thè study were compared with thè clinical and functional data of thè patients. On entry, low levels of elastase-1 were found in 11.7% of thè patients, high levels in 41.1%; in centrasi, high levels of trypsin and lipase were found in only a small number of patients (5.8 and 11.7%, respectively), whereas low levels were present in a substantial number (47.8 and 32.3% for trypsin and lipase, respectively). Over time, we found a significant (p = 0.000002) reduction in elastase-1 levels. Such reduction was not found for trypsin, lipase, or amylase. The reduction of serum elastase-1 was significantly (p< 0.003) more frequent in patients presenting a reduction in painful relapses than in patients with a stable or increased attack rate; this associa-tion was weaker (p< 0.05) for lipase and trypsin, and absent for amylase. No correlation was found between circulating enzymes and either alcohol consumption or age of patients. In patients with severe exocrine impair-ment, low levels of elastase were found in only 20% of thè cases, whereas trypsin and lipase were reduced in 73.3 and 53.3% of thè cases, respectively. In conclusion, in chronic pancreatitis patients, when serum is sam-pled in thè absence of painful relapses, trypsin and lipase serum levels are often low, mainly in thè presence of functional impairment; elastase-1 is often increased and mirrors thè frequency of painful relapses.