Managing Elevated GOT and GPT Levels in Hepatitis B Patients

The patient has hepatitis B and has experienced elevated GOT and GPT levels in the past two years?

In the past two years, my GOT and GPT levels have been consistently high, around 60 to 116.
I have been taking the medication prescribed by your hospital for about three months now, but there has been no decrease in these levels.
Are there any other more effective options available?

Mr. Chen, 50~59 year old female. Ask Date: 2005/04/06

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, first we need to rule out other causes that can lead to elevated AST (GOT) and ALT (GPT) levels, such as bile duct stones, tumors, alcohol consumption, and medications that may cause abnormal liver function tests.
If there are no other causes and the elevation is solely due to hepatitis B, you may consider taking liver protection supplements and continue monitoring.
You may also consider antiviral medications for hepatitis B (such as Tenofovir or Hepsera), but these medications can be expensive, and insurance coverage has specific criteria (such as ALT levels needing to be greater than 200).
Long-term use is required, and there is a potential risk of developing drug resistance.
It is recommended for patients to maintain a regular lifestyle, avoid self-medication and alcohol, and have regular follow-up appointments.
This response is provided by Dr.
Yuan Hong-Dao from the Department of Internal Medicine.

Reply Date: 2005/04/06

More Info

Managing elevated GOT (AST) and GPT (ALT) levels in patients with Hepatitis B can be a complex process that requires a comprehensive understanding of the underlying condition, treatment options, and lifestyle modifications. Elevated liver enzymes, such as GOT and GPT, are often indicative of liver inflammation or damage, which can occur in various liver diseases, including Hepatitis B.

Understanding GOT and GPT Levels
GOT (aspartate aminotransferase) and GPT (alanine aminotransferase) are enzymes found in the liver. Normal levels for these enzymes typically range from about 10 to 40 U/L, although this can vary slightly depending on the laboratory. Elevated levels, such as those you mentioned (60 and 116), indicate liver inflammation or damage. In the context of Hepatitis B, these elevations can be due to active viral replication and liver cell injury.

Importance of Monitoring
In patients with Hepatitis B, it is crucial to monitor liver function regularly. Elevated GOT and GPT levels can signify the need for intervention, especially if they persist over time. While some fluctuations in enzyme levels are normal, consistently high levels may suggest ongoing liver inflammation or damage, necessitating further evaluation and possibly a change in treatment strategy.

Treatment Options
You mentioned that you have been on medication for three months without seeing a reduction in your enzyme levels. The standard antiviral treatments for Hepatitis B include nucleos(t)ide analogs such as entecavir and tenofovir. These medications work by suppressing the replication of the Hepatitis B virus, which can lead to a decrease in liver inflammation and, subsequently, a reduction in GOT and GPT levels.

If your current treatment is not yielding results, it may be worth discussing with your healthcare provider the possibility of switching to a different antiviral medication. Tenofovir, for example, is known for its potency and has a high barrier to resistance, making it a preferred choice for many clinicians. Additionally, combination therapy may be considered in some cases, although this is less common.

Lifestyle Modifications
In addition to pharmacological treatment, lifestyle changes can significantly impact liver health. Here are some recommendations:
1. Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support liver health. Avoiding high-fat, high-sugar, and processed foods is also advisable.

2. Alcohol: Abstaining from alcohol is crucial, as it can exacerbate liver damage and interfere with the effectiveness of antiviral medications.

3. Weight Management: Maintaining a healthy weight can reduce the risk of fatty liver disease, which can complicate Hepatitis B.

4. Regular Exercise: Engaging in regular physical activity can help improve overall health and liver function.

5. Avoiding Hepatotoxic Substances: Be cautious with medications and supplements that can harm the liver. Always consult your healthcare provider before starting any new medication or supplement.

Regular Follow-Up
It is essential to have regular follow-up appointments with your healthcare provider to monitor your liver function and adjust treatment as necessary. This may include periodic blood tests to check your GOT and GPT levels, as well as tests to assess the viral load of Hepatitis B.

Conclusion
In summary, managing elevated GOT and GPT levels in Hepatitis B patients involves a multifaceted approach that includes appropriate antiviral therapy, lifestyle modifications, and regular monitoring. If your current treatment is not effective, discussing alternative medications with your healthcare provider is crucial. Remember, each patient's situation is unique, and personalized care is essential for optimal management of Hepatitis B and its associated liver function abnormalities.

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