Persistent High Liver Enzymes: Should You Be Concerned?

Q: Persistent High Liver Enzymes: Should You Be Concerned?

Hello, Da'an： Fatty liver cannot be fully explained; consideration for a biopsy at a medical center may be necessary, but prior examination reports should be available to avoid re-examination. <br>Changhua Hospital cares about you, Chen Shidian.

I would like to ask why my liver enzymes are not decreasing?

Hello, I would like to ask: A 30-year-old male, 165 cm tall, weighing 55 kg, who exercises infrequently, does not drink alcohol, and has not been on long-term medication, has liver enzyme levels elevated to around 100-300 for the past 2-3 years.
He has blood tests every three months for monitoring and has undergone abdominal ultrasound.
He has consulted several hospitals, but doctors have been unable to identify any specific cause, only diagnosing fatty liver and prescribing medications to aid liver metabolism and protection.
However, the liver enzyme levels have not decreased.
Should I be concerned about this? Additionally, the director of the Department of Hepatobiliary and Gastroenterology at China Medical University in Taichung suggested a liver biopsy, stating that it may not necessarily reveal the cause.
Is it still necessary to proceed with this, or are there other methods to consider? Thank you very much!

Da'an, 30~39 year old female. Ask Date: 2006/02/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Da'an: Fatty liver cannot be fully explained; consideration for a biopsy at a medical center may be necessary, but prior examination reports should be available to avoid re-examination.
Changhua Hospital cares about you, Chen Shidian.

Reply Date: 2006/02/07

More Info

Persistent elevation of liver enzymes, particularly in the range of 100 to 300 U/L, can indeed be a cause for concern, even if the underlying cause is not immediately apparent. In your case, the consistent elevation over 2 to 3 years, despite regular monitoring and treatment, suggests that further investigation may be warranted.

Firstly, it’s important to understand that elevated liver enzymes, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST), can indicate liver inflammation or damage. While you mentioned that several doctors have attributed your condition to fatty liver disease (non-alcoholic fatty liver disease or NAFLD), it is crucial to rule out other potential causes. These can include viral hepatitis (such as Hepatitis B or C), autoimmune liver diseases, metabolic disorders, and even certain genetic conditions.

The fact that you do not consume alcohol and have not been on long-term medication is a positive aspect, as these are common contributors to liver enzyme elevation. However, lifestyle factors such as diet, exercise, and weight can significantly influence liver health. Given your weight and height, your Body Mass Index (BMI) is on the lower side, but it’s essential to consider other factors such as body composition and overall metabolic health.

Regarding the suggestion of a liver biopsy, this procedure can provide valuable information about the state of your liver. It can help determine the degree of inflammation, fibrosis, or cirrhosis, and can sometimes identify conditions that blood tests and imaging studies cannot. While it is true that a biopsy may not always yield a definitive diagnosis, it can still be a useful tool in assessing the severity of liver disease and guiding treatment decisions.

If you are hesitant about undergoing a biopsy, you might consider discussing alternative non-invasive tests with your healthcare provider. These can include elastography (FibroScan), which measures liver stiffness and can indicate fibrosis, or advanced blood tests that assess liver function and damage more comprehensively.

In addition to further testing, it may be beneficial to focus on lifestyle modifications that can support liver health. This includes maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while avoiding processed foods high in sugar and unhealthy fats. Regular physical activity can also help improve liver function and overall health.

Lastly, it’s crucial to maintain open communication with your healthcare provider. If you feel that your concerns are not being adequately addressed, seeking a second opinion from a hepatologist or a liver specialist may provide you with more insight and options for managing your condition.

In summary, while persistent elevation of liver enzymes can be concerning, it is essential to approach the situation holistically. Continued monitoring, lifestyle changes, and possibly further testing such as a liver biopsy or non-invasive alternatives can help clarify the underlying cause and guide appropriate management. Your health is paramount, and taking proactive steps towards understanding and improving your liver function is vital.

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