Introduction

Ever wondered how our body regulates processes like digestion of food, generation of energy, synthesis of new molecules, and breakdown of harmful toxins? Complex proteins called enzymes are known to catalyze or hasten these reactions or processes. Understanding the function of these enzymes is essential to understand the complex working of the human body and developing new treatments for a broad range of diseases and conditions. One of the most well-known enzymes is amylase which will be discussed in detail in the upcoming sections.  

What is Amylase?

Amylase is an enzyme (a protein which speeds up reactions or processes taking place in the body) which helps in the digestion process. It is mostly produced by the pancreas and salivary glands. In the early 1800s, this enzyme was called diastase and was later renamed amylase in the 20^th century. It helps in breaking carbohydrates into simple sugars. Depending upon the part of carbohydrate it acts on, amylase enzymes are divided into three categories- alpha, beta and gamma amylase. Alpha amylases are found in plants, animals, microbes and humans; beta amylases are found in plants and microbes and gamma amylases are found in plants and animals.¹

Purpose of Amylase Test^1,2

In 1908, Wohlgemuth detected amylase enzyme in urine, this led to the use of amylase enzyme as a diagnostic laboratory test. An amylase test helps in detecting the amount of amylase in your urine or blood sample. This amount is then compared with standardized levels and a report is drawn up. This test is also called as Amy test, serum amylase or urine amylase. Amylase levels may also be tested in ascitic (abdominal fluid), pleural fluid (fluid in the lungs) or peritoneal fluid (abdominal fluid).

Your health care provider may order a blood or urine amylase test if you have complaints of pancreatic disorder. Following are the symptoms which may appear suddenly or slowly:

• Nausea or vomiting
• Fever
• Pain in the belly region which may spread to the back 
• Loss of appetite
• Higher than normal heart rate
• Foul-smelling stool

An amylase test is also used to monitor the following conditions that may affect the pancreas:

• Pancreatic cancer
• Eating disorders
• Cystic fibrosis (a life-threatening disorder affecting the lungs and the digestive system)
• Alcohol use disorder
• Chronic pancreatitis 
• Gallstone removal

Conditions That Affect Amylase Levels

Following are the conditions in which the production of amylase in the body is altered:³

• Renal failure causes decreased clearance of amylase from the body resulting in
  hyperamylasemia (elevated amylase levels)
• Macro-amylasemia is a condition in which high molecular weight amylase is present in the blood
• Chronic alcoholism
• Post-operative states especially after coronary bypass
• Cancers secreting amylase

Some procedural/technical factors include:

• Collecting tubes: The presence of oxalates, EDTA or citrate in the sample collecting tube may interfere with the amylase enzyme and give you altered values. Ensure the sample collection tube given to you is clean and sterilized (made free from germs).¹
• Medications: If you are on antiretroviral drugs/anti-HIV/AIDS medicines, estrogen-containing medicines, painkillers like morphine, or blood thinners like aspirin; there are chances that these medicines will alter the levels of amylase in your body. ¹  
• Blood group: Females with O blood group have slightly higher levels of amylase in their bodies.⁴
• Stress: A study conducted by Santos et al. in 2021 stated that anxiety and stress can result in elevated levels of amylase in the body.

In my knowledge, your health condition may be in need of attention if your amylase level is abnormal. I recommend you visit your doctor and get your present symptoms, medical history, and the findings of subsequent tests evaluated. A pancreatic issue might be indicated by a high amylase level. A low amylase level may indicate cystic fibrosis, liver, kidney, and pancreatic issues.

Dr. Siddharth Gupta, B.A.M.S, M.D (Ayu)

How to Prepare and Conduct an Amylase Test²

• Amylase blood test: Your doctor or healthcare physician will require a blood sample taken from a vein of either arm. A nurse will collect a small amount of blood in a vial or test tube by using a small needle. You may experience a little burning sensation or sting when the needle is inserted in your arm, you need not panic as this hardly lasts for a few minutes and will subside on its own. If you experience any major complaints, contact your physician.
• Amylase urine test: For this test, your doctor may provide you a small container, cleansing wipe and will instruct you about the “clean catch” method of obtaining urine sample. You should keep the following points in mind while giving a urine sample:
• Wash your hands properly with soap and water and then dry them with a clean cloth.
• Open the container; ensure you do not touch the inner part of the container.
• Clean your genital area using a cleansing wipe.
• Without the container touching your body, collect urine up to the labelled mark or as instructed.
• Close the container, put it in a plastic bag or otherwise as instructed.

If you have piles or haemorrhoids that bleed or if you are in your menstrual period, you should inform your doctor in advance before going for the test.

For better results, your healthcare professional may recommend a 24-hour urine sample as the amylase levels may vary throughout the day. For this you may be given containers and will be instructed on how you should carry sample collection at home. Follow the instructions carefully.

• Peritoneal fluid amylase test: in this test, your doctor will numb your skin and withdraw a small amount of fluid into a container using a needle.

Other instructions: 

• You should avoid drinking alcohol for 24 hours or as instructed otherwise as this may affect the results.
• If a blood test is advised, you should not eat or drink anything for at least two hours or as instructed before the test.
• The normal reference range varies from laboratory to laboratory; generally, a range of 20-300 U/L is considered normal.

In my experience, the enzyme amylase’s normal range can vary minutely based on the processing done in the lab. The range in a healthy individual is between 30 to 110 U/L (units per litre). The range is 2.6 to 21.2 international units per hour (IU/h) in a urine sample.

Dr. Rajeev Singh, BAMS

Conclusion

Amylase is an enzyme produced mostly by the pancreas and the salivary glands; it helps in the digestion process. An amylase test helps in detecting the amount of amylase in your urine or blood sample. Amylase levels may also be tested in ascitic (abdominal fluid), pleural fluid (fluid in the lungs) or peritoneal fluid (abdominal fluid). It is mostly done if acute pancreatitis or inflammation of the pancreas is suspected. It may also be recommended to monitor other conditions affecting the pancreas like pancreatic cancer, eating disorder, cystic fibrosis (a life-threatening disorder affecting the lungs and the digestive system), alcohol use disorder, chronic pancreatitis and gallstone removal.

FAQ’s

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References

1. Akinfemiwa O, Zubair M, Muniraj T. Amylase. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 10, 2022. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557738/
2. Amylase [Internet]. Medline Plus. National Library of medicine; 2022 [cited 2023 May 05]. Available from: https://medlineplus.gov/lab-tests/amylase-test/ 
3. Pieper-Bigelow C, Strocchi A, Levitt MD. Where does serum amylase come from and where does it go?. Gastroenterology clinics of North America. 1990 Dec 1;19(4):793-810.Available at: https://pubmed.ncbi.nlm.nih.gov/1702756/
4. Peng YF, Goyal H, Lin H, Liu DC, Li L. Serum amylase activity altered by the ABO blood group system in Chinese subjects. Journal of clinical laboratory analysis. 2019 Jun; 33(5):e22883. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595472/
5. Santos SV, Silva LA, Terra FD, Souza AV, Espindola FS, Marziale MH, Teixeira RR, Robazzi ML. Association of salivary alpha-amylase with anxiety and stress in nursing professionals. Revista latino-americana de enfermagem. 2021 Aug 30; 29. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432589/