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Can we rely on serum lipase to diagnose acute pancreatitis?
S262
Abstracts
Purpose: Recent guidelines have endorsed the test and treat strategy (TT) for H. pylori (Hp) in uninvestigated dyspepsia (D). As cure of Hp offers little, if any, benefit over placebo in nonulcer dyspepsia (NUD), the clinical benefits of TT are largely attributable to ulcer cure. We used decision analysis to evaluate the cost-effectiveness of TT vs. empiric antisecretory therapy (PPI) in an environment where Hp prevalence is falling and the likelihood of Hp (⫺) ulcer is rising. Methods: A symptom-driven decision analytic model estimated cost/patient treated with D comparing PPI (1 mo ⫽ $90) to TT ($30/test; treatment for HP⫹ $190). EGD ($700) was performed and guided therapy for treatment failures or symptom recurrence. We assumed no benefit of Hp therapy in NUD. We varied Hp prevalence, ulcer likelihood in D population, and % of ulcers due to Hp. Results: The figure shows a threshold curve (75% ulcers due to Hp) on which each point represents identical cost/patient for TT and PPI. In the area above the curve, TT is less costly than PPI. At a given Hp prevalence, as ulcer likelihood (y-axis) increases, TT is favored. At a fixed ulcer likelihood, as Hp prevalence (x-axis) increases, PPI is favored. PPI is favored as the proportion of ulcers due to Hp decreases. If a second PPI course is used for symptom relapse but TT failure leads to prompt EGD, PPI is always less costly than TT. Conclusions: As Hp prevalence and the proportion of ulcers due to Hp decrease, initial PPI represents a cost-effective alternative to TT. Decision analysis can be used to evaluate the impact of local Hp prevalence rates, proportion of dyspeptics with ulcer, and the fraction of ulcers related to Hp to guide initial cost-effective management strategies for patients with uninvestigated dyspepsia. 837 Can we rely on serum lipase to diagnose acute pancreatitis? Marcia R Cruz-Correa, MD1, Ivana A Vaughn1, Sanjay Jagannath, MD1, Sergey V Kantsevoy, MD1, Cheryll A Vaughn, RN1 and Anthony N Kalloo, MD1*. 1Medicine, Johns Hopkins University, Baltimore, MD, United States. Purpose: Serum lipase has been touted to be highly specific for diagnosis of acute pancreatitis. However, the diagnostic accuracy of serum lipase appears to vary according to the assay and methodology used. The more recently developed colorimetric assay that is the current standard has a reported sensitivity and specificity ranging form 80-100 percent in laboratory studies; whether the new colorimetric assay is accurate in the clinical setting remains uncertain. We evaluated the diagnostic accuracy of serum lipase as determined by a colorimetric assay to diagnose pancreatitis in patients who presented with abdominal pain using computed tomography (CT) of the abdomen as the gold standard. We also evaluated whether the addition of serum amylase to serum lipase improves the diagnostic accuracy of acute pancreatitis. Methods: We reviewed 354 consecutive patients that presented with abdominal pain and had serum lipase, amylase, and abdominal CT scan as part of their clinical evaluation. We calculated sensitivity, specificity, PPV, NPV for serum lipase (IU/dl) and amylase (IU/dl) for the diagnosis of acute pancreatitis using CT scan as the gold standard. Additionally, we calculated the diagnostic accuracy of serum lipase according to the CT criteria (mild, moderate, severe). Results: 164 (46%) female (mean age 51.8 ⫾ 18.4), 190 (46.3%) male (mean age 51.8). 62 (17%) patients had pancreatitis (CT criteria: 48 mild, 13 moderate, 1 severe). Using the receiving operating characteristics (ROC) curve (which plots the sensitivity (or true-positive rate) to the false-positive rate) the area under the curve was 0.722 (a test with no predictive value has area of 0.5; a perfect model has area of 1.0). Conclusions: Using CT scan as the gold standard the diagnostic accuracy of serum lipase for acute pancreatitis was poor. This may be a result of the recent change to the technique of colorimetric assay. The addition of serum amylase did not improve the diagnostic accuracy of serum lipase alone.
AJG – Vol. 96, No. 9, Suppl., 2001
Lipase ⬎63 Lipase ⬎200 Lipase ⬎300 Amylase ⬎115 Lipase ⬎ 63 & Amylase ⬎ 115 CT (mild pancreatitis) CT (Mod & Severe pancreatitis)
Sensitivity (%)
Specificity (%)
PPV (%)
NPV (%)
72 58 29 71 76 64 100
72 82 92 59 70 72 72
35 40 44 27 37 27 15
93 91 86 91 93 93 100
838 Prokinetic, behavioral, and device therapies compared via an investigator derived independent outcome measure score (IDIOMS) in the treatment of severe dyspepsia and gastroparesis Teresa Cutts1, Jean Luo1, Hani Rashed1 and Thomas L Abell2*. 1 UAMS, Little Rock, AR, United States; and 2U T Memphis, Memphis, TN, United States. Purpose: Severe upper gastrointestinal motor disorders (SUGIM) including severe dyspepsia and gastroparesis, are often refractory to treatment. Several new therapies, including behavioral techniques such as autogenic biofeedback, or devices such as gastric electrical stimulation, are now available. We examined the efficacy on GI symptoms (Sx) and Health Related Quality of Life (HRQOL) of three treatment modalities: prokinetic therapy (PKT), autogenic biofeedback training (ABT), and gastric electric stimulation (GES) in SUGIM patients. Additionally, we compared these Sx improvements with a new HRQOL Investgator Derived Independ Outcome Measure (IDIOM) called ADAPS. Methods: We evaluated 123 SUGIM patients (pts): 36 pts (9 m, 27 f, mean age 40.7 yrs) treated with a 12 month (mos) course of a prokinetic (cisapride 20 mg TID); 59 pts (5 m, 54 f, mean age ⫽ 35 yrs.) participated in ABT (J Cl Pharm 34:599-608, 1994); and 28 pts (5 m, 23 f, mean age 38.6 yrs.) treated via GES (GE 116(4): A53, 1999). GI symptoms were evaluated by a Total Symptom Score (TSS: nausea, bloating, abdominal pain, anorexia, early satiety) at baseline (BL) and 12 mos. of PKT, after 10 sessions of ABT, or by GES. The IDIOM measure of ADAPS, a three question scale for illness severity, intensity, and organ involvement, was rated by investigators as previously described (GE116(4), A53, April, 99). Percent change from baseline was calculated for both Sxs and HRQOL and were compared between groups. Results: Changes were significantly different from BL to 12 mos. at the p less than 0.001 level for all three therapies. Percent change (from BL to 12 months) for TSS were: for PKT 36.4%, for ABT 16.8%. and for GES 40.5%. Percent change for ADAPS, from BL to 12 months was: for PKT 29%, for ABT 24%, and for GES 38%. Conclusions: In these SUGIM pts treated with either long-term prokinetic therapy, a behavioral treatment, or GES, all treatment groups manifested significant improvement in symptoms and HRQOL. However, the group receiving GES manifested the greatest level of change from baseline in both Sx and HRQOL. Additionally, the IDIOMS measure of ADAPS may provide a concise measure for evaluating HRQOL in pts with severe upper gastrointestinal motor disorders. Supported in part by Jannsen Pharmaceutica, Medtronic, and in Association with NASA Ames Research Center.
839 After hours telephone calls: do doctors and patients see them the same way? Christine B. Dalton1, Joseph M. Hathaway1, Shrikant I. Bangdiwala1 and Douglas A. Drossman1*. 1Div. Dig. Dis., Univ. North Carolina, Chapel Hill, NC, United States. Purpose: It has been reported that up to 25% of doctor/patient contact occurs over the telephone. Little is known about how these contacts are
Abstracts
Purpose: Recent guidelines have endorsed the test and treat strategy (TT) for H. pylori (Hp) in uninvestigated dyspepsia (D). As cure of Hp offers little, if any, benefit over placebo in nonulcer dyspepsia (NUD), the clinical benefits of TT are largely attributable to ulcer cure. We used decision analysis to evaluate the cost-effectiveness of TT vs. empiric antisecretory therapy (PPI) in an environment where Hp prevalence is falling and the likelihood of Hp (⫺) ulcer is rising. Methods: A symptom-driven decision analytic model estimated cost/patient treated with D comparing PPI (1 mo ⫽ $90) to TT ($30/test; treatment for HP⫹ $190). EGD ($700) was performed and guided therapy for treatment failures or symptom recurrence. We assumed no benefit of Hp therapy in NUD. We varied Hp prevalence, ulcer likelihood in D population, and % of ulcers due to Hp. Results: The figure shows a threshold curve (75% ulcers due to Hp) on which each point represents identical cost/patient for TT and PPI. In the area above the curve, TT is less costly than PPI. At a given Hp prevalence, as ulcer likelihood (y-axis) increases, TT is favored. At a fixed ulcer likelihood, as Hp prevalence (x-axis) increases, PPI is favored. PPI is favored as the proportion of ulcers due to Hp decreases. If a second PPI course is used for symptom relapse but TT failure leads to prompt EGD, PPI is always less costly than TT. Conclusions: As Hp prevalence and the proportion of ulcers due to Hp decrease, initial PPI represents a cost-effective alternative to TT. Decision analysis can be used to evaluate the impact of local Hp prevalence rates, proportion of dyspeptics with ulcer, and the fraction of ulcers related to Hp to guide initial cost-effective management strategies for patients with uninvestigated dyspepsia. 837 Can we rely on serum lipase to diagnose acute pancreatitis? Marcia R Cruz-Correa, MD1, Ivana A Vaughn1, Sanjay Jagannath, MD1, Sergey V Kantsevoy, MD1, Cheryll A Vaughn, RN1 and Anthony N Kalloo, MD1*. 1Medicine, Johns Hopkins University, Baltimore, MD, United States. Purpose: Serum lipase has been touted to be highly specific for diagnosis of acute pancreatitis. However, the diagnostic accuracy of serum lipase appears to vary according to the assay and methodology used. The more recently developed colorimetric assay that is the current standard has a reported sensitivity and specificity ranging form 80-100 percent in laboratory studies; whether the new colorimetric assay is accurate in the clinical setting remains uncertain. We evaluated the diagnostic accuracy of serum lipase as determined by a colorimetric assay to diagnose pancreatitis in patients who presented with abdominal pain using computed tomography (CT) of the abdomen as the gold standard. We also evaluated whether the addition of serum amylase to serum lipase improves the diagnostic accuracy of acute pancreatitis. Methods: We reviewed 354 consecutive patients that presented with abdominal pain and had serum lipase, amylase, and abdominal CT scan as part of their clinical evaluation. We calculated sensitivity, specificity, PPV, NPV for serum lipase (IU/dl) and amylase (IU/dl) for the diagnosis of acute pancreatitis using CT scan as the gold standard. Additionally, we calculated the diagnostic accuracy of serum lipase according to the CT criteria (mild, moderate, severe). Results: 164 (46%) female (mean age 51.8 ⫾ 18.4), 190 (46.3%) male (mean age 51.8). 62 (17%) patients had pancreatitis (CT criteria: 48 mild, 13 moderate, 1 severe). Using the receiving operating characteristics (ROC) curve (which plots the sensitivity (or true-positive rate) to the false-positive rate) the area under the curve was 0.722 (a test with no predictive value has area of 0.5; a perfect model has area of 1.0). Conclusions: Using CT scan as the gold standard the diagnostic accuracy of serum lipase for acute pancreatitis was poor. This may be a result of the recent change to the technique of colorimetric assay. The addition of serum amylase did not improve the diagnostic accuracy of serum lipase alone.
AJG – Vol. 96, No. 9, Suppl., 2001
Lipase ⬎63 Lipase ⬎200 Lipase ⬎300 Amylase ⬎115 Lipase ⬎ 63 & Amylase ⬎ 115 CT (mild pancreatitis) CT (Mod & Severe pancreatitis)
Sensitivity (%)
Specificity (%)
PPV (%)
NPV (%)
72 58 29 71 76 64 100
72 82 92 59 70 72 72
35 40 44 27 37 27 15
93 91 86 91 93 93 100
838 Prokinetic, behavioral, and device therapies compared via an investigator derived independent outcome measure score (IDIOMS) in the treatment of severe dyspepsia and gastroparesis Teresa Cutts1, Jean Luo1, Hani Rashed1 and Thomas L Abell2*. 1 UAMS, Little Rock, AR, United States; and 2U T Memphis, Memphis, TN, United States. Purpose: Severe upper gastrointestinal motor disorders (SUGIM) including severe dyspepsia and gastroparesis, are often refractory to treatment. Several new therapies, including behavioral techniques such as autogenic biofeedback, or devices such as gastric electrical stimulation, are now available. We examined the efficacy on GI symptoms (Sx) and Health Related Quality of Life (HRQOL) of three treatment modalities: prokinetic therapy (PKT), autogenic biofeedback training (ABT), and gastric electric stimulation (GES) in SUGIM patients. Additionally, we compared these Sx improvements with a new HRQOL Investgator Derived Independ Outcome Measure (IDIOM) called ADAPS. Methods: We evaluated 123 SUGIM patients (pts): 36 pts (9 m, 27 f, mean age 40.7 yrs) treated with a 12 month (mos) course of a prokinetic (cisapride 20 mg TID); 59 pts (5 m, 54 f, mean age ⫽ 35 yrs.) participated in ABT (J Cl Pharm 34:599-608, 1994); and 28 pts (5 m, 23 f, mean age 38.6 yrs.) treated via GES (GE 116(4): A53, 1999). GI symptoms were evaluated by a Total Symptom Score (TSS: nausea, bloating, abdominal pain, anorexia, early satiety) at baseline (BL) and 12 mos. of PKT, after 10 sessions of ABT, or by GES. The IDIOM measure of ADAPS, a three question scale for illness severity, intensity, and organ involvement, was rated by investigators as previously described (GE116(4), A53, April, 99). Percent change from baseline was calculated for both Sxs and HRQOL and were compared between groups. Results: Changes were significantly different from BL to 12 mos. at the p less than 0.001 level for all three therapies. Percent change (from BL to 12 months) for TSS were: for PKT 36.4%, for ABT 16.8%. and for GES 40.5%. Percent change for ADAPS, from BL to 12 months was: for PKT 29%, for ABT 24%, and for GES 38%. Conclusions: In these SUGIM pts treated with either long-term prokinetic therapy, a behavioral treatment, or GES, all treatment groups manifested significant improvement in symptoms and HRQOL. However, the group receiving GES manifested the greatest level of change from baseline in both Sx and HRQOL. Additionally, the IDIOMS measure of ADAPS may provide a concise measure for evaluating HRQOL in pts with severe upper gastrointestinal motor disorders. Supported in part by Jannsen Pharmaceutica, Medtronic, and in Association with NASA Ames Research Center.
839 After hours telephone calls: do doctors and patients see them the same way? Christine B. Dalton1, Joseph M. Hathaway1, Shrikant I. Bangdiwala1 and Douglas A. Drossman1*. 1Div. Dig. Dis., Univ. North Carolina, Chapel Hill, NC, United States. Purpose: It has been reported that up to 25% of doctor/patient contact occurs over the telephone. Little is known about how these contacts are