Persistently Elevated Liver Enzymes: Causes and Insights

Liver enzyme levels have consistently been elevated?

Hello Doctor: I am 26 years old, and I have had normal health check-ups before university.
However, since my university entrance examination, my liver enzymes GPT and GOT have been slightly elevated above normal values.
Since then, I have followed my doctor's advice to have blood tests every six months and undergo abdominal ultrasounds.
Over the years, the ultrasounds have shown no significant issues, but the enzyme levels have consistently remained slightly above the normal range.
I would like to ask for your opinion.
I have consulted several doctors over the years, and their opinions vary.
Some prescribe liver-protective medications for one or two months, but the follow-up tests still show slightly elevated levels.
Other doctors say that slightly elevated levels are still considered normal.
Additionally, I occasionally experience a dull sensation in my upper right abdomen, and with the increased academic pressure over the past two years, it seems to have become more frequent, though I am unsure if it's just my perception.
I would appreciate your professional advice to help me better understand my situation for future discussions with my doctors.
Thank you! Also, what could be the potential causes of my consistently slightly elevated enzyme levels (approximately 10 points above normal)? I would like to add that my blood tests have shown no history of viral hepatitis, and I do not have a habit of drinking alcohol.
I hope this information is helpful for your reference.

Aren, 20~29 year old female. Ask Date: 2005/02/19

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, the common reasons for elevated AST (GOT) and ALT (GPT) levels include hepatitis B and C, drug-induced fatty liver, and autoimmune diseases.
A small portion of cases may have unknown causes not related to the currently known hepatitis viruses (A, B, C, D, E).
If the liver ultrasound is normal (excluding tumors, intrahepatic stones, fatty liver, and cirrhosis) and other liver function tests (albumin, bilirubin, alkaline phosphatase) are normal, with only slight elevations in AST and ALT, and no history of hepatitis B, hepatitis C, or alcohol consumption, then in Taiwan, the risk of cirrhosis and liver cancer is significantly reduced.
It is recommended to continue monitoring, maintain liver health, and assess for conditions such as obesity, hyperlipidemia, medication use, or exposure to chemicals.
If necessary, a liver biopsy may help determine the correct cause.
Additionally, for persistent pain in the right upper abdomen, differential diagnoses include liver, gallbladder, intestinal, gastric, kidney diseases, and neuralgia or pleuritis.
If the pain is frequent, it is best to consult a physician in person.
Wishing you good health, Dr.
Lin Ming-Hui, Internal Medicine.

Reply Date: 2005/02/19

More Info

Understanding persistently elevated liver enzymes, particularly GPT (ALT) and GOT (AST), is crucial for assessing liver health and identifying potential underlying conditions. In your case, where these enzymes have consistently remained slightly above normal levels without significant changes over the years, it is essential to consider various factors that could contribute to this phenomenon.

Firstly, it is important to recognize that mildly elevated liver enzymes can be caused by a range of conditions, some of which may not be immediately apparent. Common causes include:
1. Non-Alcoholic Fatty Liver Disease (NAFLD): This is one of the most prevalent causes of elevated liver enzymes, especially in individuals who are overweight or have metabolic syndrome. NAFLD can occur even in the absence of significant alcohol consumption and is often associated with obesity, insulin resistance, and dyslipidemia.

2. Medications and Supplements: Certain medications, including over-the-counter pain relievers like acetaminophen, as well as herbal supplements, can lead to liver enzyme elevation. It is essential to review any medications or supplements you are taking with your healthcare provider.

3. Autoimmune Conditions: Conditions such as autoimmune hepatitis can cause elevated liver enzymes. This is characterized by the immune system attacking liver cells, leading to inflammation and damage.

4. Chronic Viral Hepatitis: Although you mentioned not having a history of viral hepatitis, it is still worth noting that chronic infections can sometimes present with mild elevations in liver enzymes.

5. Muscle Injury: Since AST is also found in muscle tissue, any muscle injury or strenuous exercise can lead to elevated AST levels, which may not necessarily indicate liver damage.

6. Metabolic Disorders: Conditions such as hemochromatosis or Wilson's disease can also lead to elevated liver enzymes and should be considered, especially if there is a family history of liver disease.

Given your situation, where you have experienced stable but slightly elevated liver enzymes over several years, it is advisable to continue regular monitoring through blood tests and imaging studies like ultrasound. The fact that your ultrasounds have shown no significant abnormalities is reassuring, but the persistent elevation warrants further investigation.

Recommendations:
1. Lifestyle Modifications: Focus on maintaining a healthy diet, engaging in regular physical activity, and managing stress. Weight loss, if applicable, can significantly improve liver enzyme levels, particularly in cases of NAFLD.

2. Regular Monitoring: Continue with your routine blood tests every six months as recommended by your healthcare provider. This will help track any changes in liver enzyme levels and overall liver function.

3. Consultation with a Specialist: If your liver enzymes remain elevated, consider seeking a referral to a hepatologist or a gastroenterologist specializing in liver diseases. They may recommend additional tests, such as a liver biopsy or advanced imaging studies, to assess liver health more comprehensively.

4. Avoid Alcohol and Toxins: Since you do not consume alcohol, continue to avoid it, as well as any unnecessary medications or supplements that could stress the liver.

5. Discuss Symptoms: If you experience any new symptoms, such as increased abdominal discomfort, jaundice, or changes in appetite, be sure to discuss these with your doctor promptly.

In summary, while mildly elevated liver enzymes can be concerning, they are not always indicative of severe liver disease. With appropriate lifestyle changes, regular monitoring, and open communication with your healthcare providers, you can manage your liver health effectively.

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