Persistent High Liver Enzymes: Causes and Concerns - Gastroenterology and Hepatology

The GPT index remains consistently high?

The health check revealed that liver enzyme levels have consistently been above 200.
I have undergone a self-paid liver examination package, which showed no hepatitis A, B, or C; I have antibodies for hepatitis B, no alcoholic liver disease, but there is evidence of fatty liver and signs of diabetes.
The examining physician is also puzzled as to why the enzyme levels remain elevated.
Could this be classified as chronic hepatitis? I feel a bit lost since the cause cannot be identified.

he li, 30~39 year old female. Ask Date: 2008/10/08

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
Non-alcoholic fatty liver disease (NAFLD) has become a leading cause of chronic hepatitis in Western countries, second only to viral hepatitis, and is highly associated with metabolic syndrome, including obesity, type 2 diabetes, hyperlipidemia, and insulin resistance.

2.
Non-pharmacological treatments include weight loss, exercise, management of diabetes and hyperlipidemia, avoiding exposure to toxic substances, and refraining from alcohol and hepatotoxic medications.

Wishing you good health,
Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health.

Reply Date: 2008/10/08

More Info

Persistent high liver enzymes, particularly elevated levels of AST (SGOT) and ALT (SGPT), can be concerning and often indicate underlying liver issues. In your case, with liver enzyme levels consistently above 200, it is essential to explore potential causes and implications thoroughly.

Possible Causes of Elevated Liver Enzymes
1. Non-Alcoholic Fatty Liver Disease (NAFLD): Given your mention of fatty liver and diabetes, NAFLD is a likely contributor. This condition is characterized by the accumulation of fat in liver cells and is often associated with obesity, insulin resistance, and metabolic syndrome. It can lead to inflammation (non-alcoholic steatohepatitis, or NASH) and potentially progress to cirrhosis if not managed.

2. Chronic Hepatitis: While your tests ruled out hepatitis A, B, and C, chronic hepatitis can still occur due to other viral infections, autoimmune conditions, or even drug-induced liver injury. It’s crucial to consider that some individuals may have chronic hepatitis without clear serological markers.

3. Metabolic Disorders: Conditions like hemochromatosis or Wilson's disease can lead to liver damage and elevated enzymes. These disorders often require specific tests to diagnose.

4. Medications and Toxins: Certain medications, over-the-counter drugs, and herbal supplements can cause liver enzyme elevations. It’s important to review all substances you are taking with your healthcare provider.

5. Other Conditions: Conditions such as thyroid disorders, celiac disease, and certain infections can also affect liver function.

Concerns Regarding Chronic Liver Disease
Your concern about whether this constitutes chronic liver disease is valid. Chronic liver disease is typically defined by the presence of liver inflammation or damage lasting more than six months. Given that your liver enzymes are persistently elevated, it is essential to monitor for signs of liver damage or progression to more severe liver disease, such as cirrhosis.

Recommended Actions
1. Regular Monitoring: Regular follow-up with your healthcare provider is crucial. They may recommend periodic liver function tests to monitor your enzyme levels and assess liver health.

2. Imaging Studies: Ultrasound or other imaging studies can help evaluate the liver's structure and detect any abnormalities, such as fatty infiltration or fibrosis.

3. Lifestyle Modifications: Since you mentioned having diabetes and fatty liver, lifestyle changes are vital. This includes adopting a balanced diet, engaging in regular physical activity, and managing your blood sugar levels effectively. Weight loss can significantly improve liver health in cases of NAFLD.

4. Further Testing: If the cause of elevated liver enzymes remains unclear, your doctor may suggest additional tests, such as liver biopsy, elastography, or specialized blood tests to assess liver fibrosis.

5. Avoid Alcohol and Toxins: Even if you do not have alcoholic liver disease, avoiding alcohol and other potential liver toxins is advisable to prevent further liver damage.

Conclusion
Persistent high liver enzymes warrant careful evaluation and management. While you may not have traditional markers of chronic hepatitis, the combination of fatty liver and diabetes suggests a need for proactive management to prevent progression to more severe liver disease. Collaborate closely with your healthcare provider to develop a comprehensive plan tailored to your specific situation. Regular monitoring, lifestyle changes, and further investigations will be key to managing your liver health effectively.

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