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Isolated Amylase Deficiency in Children and Its Clinical Implication

Hopson, Puanani*; Patel, Samit*; Bornstein, Jeffrey; Mehta, Devendra; Horvath, Karoly

Journal of Pediatric Gastroenterology and Nutrition: June 2019 - Volume 68 - Issue 6 - p 854–860
doi: 10.1097/MPG.0000000000002317
Original Article: Pancreatology

Objectives: Among the 3 lines of pancreatic enzymes, amylase secretion develops last and it is not detected in duodenal aspirates of infants in the first month after birth. The aim of this study was to assess the prevalence and symptoms of isolated amylase deficiency in children.

Methods: During a 6-year period, we performed endoscopic pancreatic function tests (ePFT) in 712 children. Isolated amylase deficiency was defined as activity that was below the third percentile of our referenced population with normal lipase and protease activities.

Results: Seventy-two children between age 0.21 and 15.7 years (boys, n = 35) had isolated amylase deficiency. The highest prevalence of isolated amylase deficiency was found in patients less than 6 months of age (52.9%). From 6 months to 1 year of age, the prevalence was 40%. The prevalence gradually decreased until 18 months. Failure to thrive, poor weight gain, diarrhea, and abdominal bloating were the most frequent indications for ePFT. Eleven children had repeat ePFT after initial diagnosis and 6 had normal enzyme activity, whereas 5 had remained amylase-deficient an average of 1.65 years later.

Conclusions: The prevalence of selective amylase deficiency was 10.1% in the 712 children who underwent ePFT with the suspicion of malabsorption. Low amylase activity is “physiologic” in infants <6 months of age, however, this study supports that it should be considered in the differential diagnosis in children older than 6 months of age.

*Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, University of Florida

The Florida State University, Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL.

Address correspondence and reprint requests to Puanani Hopson, DO, Center for Digestive Health and Nutrition, Arnold Palmer Hospital for Children, 60W Gore Street, Orlando, FL 32806 (e-mail:

Received 24 July, 2018

Accepted 3 February, 2019

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,