Diagnostic role of rapid urinary trypsinogen-2 strip test in acute pancreatitis


  • Meenal Jain Department of Surgery, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
  • Vinoth Sundaresan Department of Surgery, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
  • Siddhartha Gowthaman Department of Surgery, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
  • Ramanathan Manickam Department of Surgery, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India




Acute pancreatitis, Urinary trypsinogen, Amylase, Lipase


Acute pancreatitis is one of the most common surgical conditions that present with acute abdomen. Serum amylase and lipase are one of the most important and widely used laboratory methods to diagnosis acute pancreatitis. However, these tests have had unsatisfactory results in terms of their sensitivity and specificity. Urinary trypsinogen-2 strip test has been developed for the detection of increased levels of trypsinogen-2 in urine and has been suggested to play an important role in the screening of aucte pancreatitis on the basis of its rapid results. In this review, we aimed to assess the diagnostic role of the same existing articles using databases like pubmed, google scholar, medline, pubmed central. We analysed about 50 articles all of which were in English and 15 were excluded on the basis of our subject criteria.



Brunicardi FC. Schwartz’s principles of surgery. In: Andersen DK, Billiar TR, Dunn DL, Kao LS, Hunter JG, Matthews JB, Pollock RE. Eleventh ed. New York: McGraw-Hill; 2018.

Kemppainen EA, Hedström JI, Puolakkainen PA, Sainio VS, Haapiainen RK, Perhoniemi V, et al. Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. N Engl J Med. 1997;336(25):1788-93.

Corfield AP, Cooper MJ, Williamson RC, Mayer AD, McMahon MJ, Dickson AP, et al. Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices. Lancet. 1985;2(8452):403-7.

Clavien PA, Robert J, Meyer P, Borst F, Hauser H, Herrmann F, et al. Acute pancreatitis and normoamylasemia. Not an uncommon combination. Ann Surg. 1989;210(5):614-20.

Itkonen O, Koivunen E, Hurme M, Alfthan H, Schröder T, Stenman UH. Time-resolved immunofluorometric assays for trypsinogen-1 and 2 in serum reveal preferential elevation of trypsinogen-2 in pancreatitis. J Lab Clin Med. 1990;115(6):712-8.

Marshall JB. Acute pancreatitis. A review with an emphasis on new developments. Arch Intern Med. 1993;153(10):1185-98.

Yousaf M, McCallion K, Diamond T. Management of severe acute pancreatitis. Br J Surg. 2003;90(4):407-20.

Toouli J, Brooke-Smith M, Bassi C, Carr-Locke D, Telford J, Freeny P, Imrie C, et al, Working Party of the Program Commitee of the Bangkok World Congress of Gastroenterology 2002. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002;17:15-39.

Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med. 1994;330(17):1198-210.

Lankisch PG, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB. Acute pancreatitis: does gender matter? Dig Dis Sci. 2001;46(11):2470-4.

Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27.

Simpson KW, Simpson JW, Lake S, Morton DB, Batt RM. Effect of pancreatectomy on plasma activities of amylase, isoamylase, lipase and trypsin-like immunoreactivity in dogs. Res Vet Sci. 1991;51(1):78-82.

Elman R. Value of blood amylase estimations in the diagnosis of pancreatic disease: a clinical study. Arch Surg. 1929;19(6):943.

Cherry IS, Crandall LA. The specificity of pancreatic lipase: its appearance in the blood after pancreatic injury. American Journal of Physiology-Legacy Content. 1932;100(2):266-73.

Cartier T, Sogni P, Perruche F, Meyniard O, Claessens Y-E, Dhainaut J-F, et al. Normal lipase serum level in acute pancreatitis: a case report. Emergency Med J. 2006;23(9):701.

Rompianesi G, Hann A, Komolafe O, Pereira SP, Davidson BR, Gurusamy KS. Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis. Cochrane Database Syst Rev. 2017;4(4):012010.

Spechler SJ, Dalton JW, Robbins AH, Gerzof SG, Stern JS, Johnson WC, et al. Prevalence of normal serum amylase levels in patients with acute alcoholic pancreatitis. Digest Dis Sci. 1983;28(10):865-9.

Albo R, Silen W, Goldman L. A critical clinical analysis of acute pancreatitis. Arch Surg. 1963;86:1032-8.

Smith RC, Southwell-Keely J, Chesher D. Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis? ANZ J Surg. 2005;75(6):399-404.

Chang J, Chung C. Diagnosing Acute Pancreatitis: Amylase or Lipase? Hong Kong Journal of Emergency Medicine. 2011;18(1):20-5.

Batra HS, Kumar A, Saha TK, Misra P, Ambade V. Comparative study of serum amylase and lipase in acute pancreatitis patients. Indian J Clin Biochem. 2015;30(2):230-3.

Orebaugh SL. Normal amylase levels in the presentation of acute pancreatitis. Am J Emerg Med. 1994;12(1):21-4.

Frank B, Gottlieb K. Amylase Normal, Lipase Elevated: Is It Pancreatitis?: A Case Series and Review of The Literature. American J Gastroentero. 1999;94(2):463-9.

Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci. 2015;22(6):405-32.

Basnayake C, Ratnam D. Blood tests for acute pancreatitis. Aust Prescr. 2015;38(4):128-30.

Lippi G, Valentino M, Cervellin G. Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail. Critical Reviews in Clinical Laboratory Sciences. 2012;49(1):18-31.

Frossard JL. Trypsin activation peptide (TAP) in acute pancreatitis: from pathophysiology to clinical usefulness. JOP. 2001;2(2):69-77.

Mero M, Schröder T, Tenhunen R, Lempinen M. Serum phospholipase A2, immunoreactive trypsin, and trypsin inhibitors during human acute pancreatitis. Scand J Gastroenterol. 1982;17(3):413-6.

Hedström J, Leinonen J, Sainio V, Stenman UH. Time-resolved immunofluorometric assay of trypsin-2 complexed with alpha 1-antitrypsin in serum. Clin Chem. 1994;40(9):1761-5.

Hedström J, Haglund C, Haapiainen R, Stenman UH. Serum trypsinogen-2 and trypsin-2-alpha(1)-antitrypsin complex in malignant and benign digestive-tract diseases. Preferential elevation in patients with cholangiocarcinomas. Int J Cancer. 1996;66(3):326-31.

Sainio V, Puolakkainen P, Kemppainen E, Hedström J, Haapiainen R, Kivisaari L, et al. Serum trypsinogen-2 in the prediction of outcome in acute necrotizing pancreatitis. Scand J Gastroenterol. 1996;31(8):818-24.

Sáez J, Martínez J, Trigo C, Sánchez-Payá J, Compañy L, Laveda R, et al. Clinical value of rapid urine trypsinogen-2 test strip, urinary trypsinogen activation peptide, and serum and urinary activation peptide of carboxypeptidase B in acute pancreatitis. World J Gastroenterol. 2005;11(46):7261-5.

Chen YT, Chen CC, Wang SS, Chang FY, Lee SD. Rapid urinary trypsinogen-2 test strip in the diagnosis of acute pancreatitis. Pancreas. 2005;30(3):243-7.

Chandra BJS, Nitesh S. Comparative Study of Rapid Trypsinogen 2 Strip Test to Serum Amylase and Serum Lipase Estimation as a Screening Test in Acute Pancreatitis. IJSS. 2017;3(1):5.

Anandh1 P, Rekha2 A. To evaluate the efficacy of urinary trypsinogen 2 dipstick test in diagnosing acute pancreatitis. JEBHM. 2016;3(64):3501-9.






Review Articles