{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T05:30:51Z","timestamp":1791955851846,"version":"4.3.4"},"reference-count":23,"publisher":"BMJ","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"accepted":{"date-parts":[[1998,11,4]]},"published-print":{"date-parts":[[1999,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>In most treatment studies on acute pancreatitis, pancreatologists base their diagnosis on amylase\/lipase levels more than three times above the upper limit of normal (&gt;3n) and thus exclude patients with smaller enzyme level increases. The recommendations derived from the results of treatment studies do not take into account such patients. Non-pancreatologists frequently believe that only patients with high enzyme levels have a serious prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>AIMS<\/jats:title>\n                    <jats:p>To question the assumption that high enzyme levels indicate severe, and conversely low enzyme levels indicate mild, acute pancreatitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PATIENTS\/METHODS<\/jats:title>\n                    <jats:p>This retrospective study includes 284 consecutive patients with a first attack of acute pancreatitis. The cause was biliary in 114 (40%) patients, alcoholism in 83 (29%), other in 21 (7%), and unknown in 66 (23%). Patients were divided into two groups according to their serum enzyme levels (amylase: \u2a7d3n, n = 88; &gt;3n, n = 196; lipase: \u2a7d3n, n = 51; &gt;3n, n = 233). Renal impairment, indication for dialysis and artificial ventilation, development of pseudocysts, necessity for surgery, and mortality were taken as parameters of severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The incidence of severity was the same for both the \u2a7d3n and &gt;3n groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The severity of acute pancreatitis is independent of the elevation in serum amylase\/lipase level (\u2a7d3n or &gt;3n) on admission. Patients with only a slight increase can also have or develop severe acute pancreatitis. Patients with \u2a7d3n elevated enzyme levels on admission represent a substantial group that treatment studies have frequently overlooked. This is especially true for patients with alcohol induced acute pancreatitis whose amylase levels are lower than in other aetiological groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gut.44.4.542","type":"journal-article","created":{"date-parts":[[2010,1,8]],"date-time":"2010-01-08T21:47:15Z","timestamp":1262987235000},"page":"542-544","source":"Crossref","is-referenced-by-count":112,"title":["Underestimation of acute pancreatitis: patients with only a small increase in amylase\/lipase levels can also have or develop severe acute pancreatitis"],"prefix":"10.1136","volume":"44","author":[{"given":"P G","family":"Lankisch","sequence":"first","affiliation":[{"name":"aDepartment of Internal Medicine, Municipal Hospital of L\u00fcneburg, L\u00fcneburg, Germany, \n\nbInstitute for Statistics and Econometrics, University of G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Burchard-Reckert","sequence":"additional","affiliation":[{"name":"aDepartment of Internal Medicine, Municipal Hospital of L\u00fcneburg, L\u00fcneburg, Germany, \n\nbInstitute for Statistics and Econometrics, University of G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Lehnick","sequence":"additional","affiliation":[{"name":"aDepartment of Internal Medicine, Municipal Hospital of L\u00fcneburg, L\u00fcneburg, Germany, \n\nbInstitute for Statistics and Econometrics, University of G\u00f6ttingen, G\u00f6ttingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1999,4,1]]},"reference":[{"key":"2025121313515886000_44.4.542.1","first-page":"632","article-title":"Death from acute pancreatitis.","volume":"2","year":"1977","journal-title":"Lancet"},{"key":"2025121313515886000_44.4.542.2","doi-asserted-by":"crossref","first-page":"881","DOI":"10.3109\/00365527909181420","article-title":"A double-blind trial of synthetic salmon calcitonin in the treatment of acute pancreatitis.","volume":"14","author":"Goebell","year":"1979","journal-title":"Scand J Gastroenterol"},{"key":"2025121313515886000_44.4.542.3","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1055\/s-0028-1103955","article-title":"Einflu\u03b2 von Salm-Calcitonin auf den Verlauf der akuten Pankreatitis. Ergebnisse einer prospektiven Doppelblindstudie.","volume":"104","author":"Paul","year":"1979","journal-title":"Dtsch Med Wochenschr"},{"key":"2025121313515886000_44.4.542.4","doi-asserted-by":"publisher","DOI":"10.1136\/gut.21.4.334"},{"key":"2025121313515886000_44.4.542.5","first-page":"992","article-title":"Treatment of acute pancreatitis with somatostatin: results of the multicenter double-blind trial (APTS-study) [abstract].","volume":"30","author":"Usadel","year":"1985","journal-title":"Dig Dis Sci"},{"key":"2025121313515886000_44.4.542.6","first-page":"200","article-title":"Gabexat mesilat in der Behandlung der akuten Pankreatitis. Ergebnisse der hannoverschen multizentrischen Doppelblindstudie mit 50 Patienten.","volume":"24","author":"Freise","year":"1986","journal-title":"Z Gastroenterol"},{"key":"2025121313515886000_44.4.542.7","doi-asserted-by":"publisher","DOI":"10.1136\/gut.30.2.223"},{"key":"2025121313515886000_44.4.542.8","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1016\/0016-5085(93)90288-N","article-title":"Gabexate mesilate in human acute pancreatitis.","volume":"104","author":"B\u00fcchler","year":"1993","journal-title":"Gastroenterology"},{"key":"2025121313515886000_44.4.542.9","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800821039"},{"key":"2025121313515886000_44.4.542.10","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800840912"},{"key":"2025121313515886000_44.4.542.11","doi-asserted-by":"publisher","DOI":"10.1136\/gut.25.7.756"},{"key":"2025121313515886000_44.4.542.12","first-page":"921","article-title":"Significance of the serum amylase determination.","volume":"147","author":"Abruzzo","year":"1958","journal-title":"Ann Surg"},{"key":"2025121313515886000_44.4.542.13","first-page":"877","article-title":"Significance of an elevated serum amylase.","volume":"63","author":"Adams","year":"1968","journal-title":"Surgery"},{"key":"2025121313515886000_44.4.542.14","doi-asserted-by":"publisher","DOI":"10.1136\/gut.33.7.982"},{"key":"2025121313515886000_44.4.542.15","first-page":"213","article-title":"High, not low, amylase and lipase levels indicate severe acute pancreatitis.","volume":"32","author":"Lankisch","year":"1994","journal-title":"Z Gastroenterol"},{"key":"2025121313515886000_44.4.542.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(97)70185-9"},{"key":"2025121313515886000_44.4.542.17","first-page":"A455","article-title":"The development of pancreatic necrosis and multi-system organ failure is not a parallel event in acute pancreatitis (AP) [abstract].","volume":"112","author":"Lankisch","year":"1997","journal-title":"Gastroenterology"},{"key":"2025121313515886000_44.4.542.18","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(76)90386-X"},{"key":"2025121313515886000_44.4.542.19","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800680407"},{"key":"2025121313515886000_44.4.542.20","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/00006676-198804000-00008","article-title":"Correlation of serum amylase levels with pancreatic pathology and pancreatitis etiology.","volume":"3","author":"Nordestgaard","year":"1988","journal-title":"Pancreas"},{"key":"2025121313515886000_44.4.542.21","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(87)90261-3"},{"key":"2025121313515886000_44.4.542.22","first-page":"1755","article-title":"The admission serum lipase:amylase ratio differentiates alcoholic from nonalcoholic acute pancreatitis.","volume":"87","author":"Tenner","year":"1992","journal-title":"Am J Gastroenterol"},{"key":"2025121313515886000_44.4.542.23","first-page":"8","article-title":"Lipase\/amylase ratio: not helpful in the early etiological differentiation of acute pancreatitis.","volume":"32","author":"Lankisch","year":"1994","journal-title":"Z Gastroenterol"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.44.4.542","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T21:52:05Z","timestamp":1765662725000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.44.4.542"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,4,1]]},"references-count":23,"journal-issue":{"issue":"4","published-online":{"date-parts":[[1999,4,1]]},"published-print":{"date-parts":[[1999,4,1]]}},"alternative-id":["10.1136\/gut.44.4.542"],"URL":"https:\/\/doi.org\/10.1136\/gut.44.4.542","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1999,4,1]]}}}