Elevated lipase (160-170) for 6 months, Amalyze normal,no diagnosis yet

[himu]

Hello,
In Sep 2003, i had a slight lower right abdomenal (abdominal) pain.My primary physician asked me to do a blood test. Results showed elevated lipase(169) , but normal amalyze. Not other parameter abnormal.I took a CT scan then .Everything came out normal. In meantime i had a streching pain in right side of abdomen and stool discharge was sometimes very loose in nature. I went for couple of more blood tests but lipase was still high. Then i went to gastro specialist. He did a endoscopy and colonoscopy. Pancreas and everything else normal. I had a small hernia but he asked me not to bother. Also he thought I had IBS and asked me to relax and drink lot of water. This happened in course of 3 months Sep,Oct Nov 03.
    Now again (Apr 04) i took a blood test and lipase is still at 177. My primary physician has asked to take a second opinion from another specialist, and he says he cant make out why the enzyme is high for so long. My question is:
1. Is lipase staying high for such a long time indicate any specific problem which is there or can develop.
1. What can be effects if it stays high for long time.
2. Are there any other tests which can give more details.
3. Is it related to some other problem like any duct being blocked or intestine (IBS).
4. Can you analyze the symptoms and give some direction as to what might the problem be. Right now i see some white mass in my stool sometimes.
No major digestion problems though.Sometimes i have constipation.But not so problematic.
Right now i am just going by what the physician is suggesting.
Also i am 30 yrs old. I do not smoke and i am vegeterian. I do not drink alcohol.
What are your views about my case.

[Kevin Pho, MD]

Lipase is elevated in patients with renal failure and can also be elevated in several other conditions other than pancreatitis.  This can include cholecystitis, bowel obstruction, ulcers, diabetic ketoacidosis, HIV, or medications to name a few.

The effects of a high lipase would depend on what is causing the elevation.

You may want to consider an ultrasound to evaluate the liver and gallbladder.  An ERCP or MRCP can be considered to evaluate the biliary ducts.

Although possible, I am not aware of IBS itself raising the lipase level.

As stated above, I would suggest a gallbladder evaluation (starting with an ultrasound).  If negative, you may want further evaluation of the biliary ducts.  

You can discuss these options with your gastroenterologist.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Gelrud.  Approach to the patient with elevated serum amylase or lipase.  UptoDate, 2004.

[Olivia723]

A related discussion, Elevated lipase level was started.