UpFront

We (mostly) think of abnormal serum amylase as being elevated. In this issue, Jalal and colleagues report a systematic review of the conditions associated with low serum amylase. The authors found 19 studies reporting 15 097 patients. The main conditions associated with low serum amylase were diabetes mellitus, metabolic syndrome, chronic pancreatitis (CP), non-alcoholic fatty liver disease and obesity. Low serum amylase showed a high specificity (94%) with low sensitivity (38.7%–59%) in diagnosing CP. The clinical implications are of interest. The authors suggest low amylase can be part of a metabolic process making it a useful metabolic marker in cases like obesity, metabolic syndrome and diabetes mellitus. It can be used as an exocrine marker and trigger investigation for pancreatic exocrine insufficiency. (See page 153) Chronic abdominal pain is common in inflammatory bowel disease (IBD) and not always straightforward to manage. In this issue, Baille and colleagues present a practical guide. The authors start by reviewing pain pathways (see figure 1). It is important to …