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Systematic review
What is the clinical significance of low serum amylase? Systematic review of the conditions associated with low serum amylase
  1. Mustafa Jalal1,
  2. Sebastine A Gbadegesin2,
  3. Nadeem Tehami3,
  4. Kei Nakajima4,5
  1. 1Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth, UK
  2. 2Department of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
  3. 3Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  4. 4Department of Food and Nutrition, Japan Women's University, Bunkyo-ku, Japan
  5. 5Department of Endocrinology and Diabetes, Saitama Medical University, Iruma-gun, Japan
  1. Correspondence to Dr Mustafa Jalal, Department of Gastroenterology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, UK; mustafa.jalal{at}


Objective Most studies have assessed the impact of elevated serum amylase levels in clinical practice, but only a few have investigated the significance of low serum amylase. We therefore, aimed to review the literature to understand the conditions associated with low serum amylase and its clinical relevance.

Method This systematic review was performed in accordance with the criteria established in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted on Medline and Embase databases until November 2022. After identifying relevant titles, abstracts were read and data of eligible articles retrieved. The conditions associated with low serum amylase were evaluated. The quality of the studies was assessed using the Newcastle-Ottawa Score.

Results Our search strategy identified 19 studies including a total of 15 097 patients for systematic review. All the studies were observational including two studies which used secretin-induced test. The main conditions associated with low serum amylase were diabetes mellitus (n=9), metabolic syndrome (n=3), chronic pancreatitis (CP) (n=3), non-alcoholic fatty liver disease (n=2) and obesity (n=1). Low serum amylase showed a high specificity (94%) with low sensitivity (38.7%–59%) in diagnosing chronic pancreatitis.

Conclusion This systematic review revealed a unique insight into the relevance of low serum amylase in clinical practice. Low serum amylase can be a useful adjunct test in the assessment of patients with CP, pancreatic exocrine insufficiency, diabetes mellitus and metabolic syndrome.

  • chronic pancreatitis
  • diabetes mellitus
  • exocrine pancreatic function

Data availability statement

There are no data in this work.

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Data availability statement

There are no data in this work.

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  • Twitter @DrM_Jalal, @helpatologist

  • Contributors MJ: conceived the idea for the review, conducted literature search, interpretation of data, wrote review protocol and first draft of the paper and acts as a guarantor. SAG: conducted literature review and interpretation of data. NT: interpretation of data and first draft. KN: conceived the idea for the review, and first draft of the paper. All authors gave their approval for the final version of the work to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.