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Clinical Hepatology pp 533–547Cite as

Approach to the Patient with Abnormal Liver Enzymes

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Abbreviations

5′-NT:

5' -nucleotidase

ACE:

Angiotensin converting enzyme

αATD:

α1-antitrypsin deficiency

AH:

Alcoholic hepatitis

AIH:

Autoimmune hepatitis

ALT:

Alanine aminotransferase

AMA:

Antimitochondrial antibodies

ANA:

Antinuclear antibodies

AP:

Alkaline phosphatase

AST:

Aspartate aminotransferase

BRIC:

Benign recurrent intrahepatic cholestasis

CAH:

Chronic active hepatitis

CBD:

Common bile duct

CFTR:

Cystic fibrosis transmembranous conductanc regulator

ChE:

Choline esterase

CMV:

Cytomegalovirus

CPH:

Chronic persistent hepatitis

CT:

Computed tomography

EBV:

Epstein Barr virus

EM:

Electron microscopy

ERCP:

Endoscopic retrograde cholangio-pancreatography

EUS:

Endoscopic ultrasonography

γ-GT:

γ-glutamyl transpeptidase (transferase)

GLDH:

Glutamate dehydrogenase

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

HH:

Hereditary hemochromatosis

HSV:

Herpes simplex virus

IBD:

Inflammatory bowel disease

IH:

Ischemic hepatitis

LAP:

Leucine aminopeptidase

LDH:

Lactate dehydrogenase

LDL:

Low density lipoproteins

LKM:

Liver kidney microsomal antibodies

MRCP:

Magnetic resonance cholangio-pancreatography

MRI:

Magnetic resonance imaging

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

pANCA:

Perinuclear anti cytoplasmic antibodies

PBC:

Primary biliary cirrhosis

PFIC:

Progressive familial intrahepatic cholestasis

PSC:

Primary sclerosing cholangitis

SAA:

Serum amyloid A

SD:

Standard deviation

SLA/LP:

Soluble liver antigen/liver-pancreas anti bodies

SMA:

Smooth muscle antibodies

TIBC:

Total iron binding capacity

ULN:

Upper limit of normal

US:

Ultrasound

WD:

Wilson' s disease

References

  1. Adibi P, Sadeghi M, Mahsa M, et al (2007) Prediction of coronary atherosclerotic disease with liver transaminase level. Liver Int 27: 895–900

    Article  CAS  PubMed  Google Scholar 

  2. Bardella MT, Vecchi M, Conte D, et al (1999) Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology 29: 654–57

    Article  CAS  PubMed  Google Scholar 

  3. Berasain C, Betés M, Panizo A, et al (2000) Pathological and virological findings in patients with persistent hyper-transaminasaemia of unknown aetiology. Gut 47: 429–35

    Article  CAS  PubMed  Google Scholar 

  4. Clark JM, Brancati FL, Diehl AM (2003) The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 98: 960–7

    Article  CAS  PubMed  Google Scholar 

  5. Cohen JA, Goffinet JA, Donabedian RK, et al (1976) Observations on decreased serum glutamic oxalacetic transaminase activity in azotemic patients. Ann Intern Med 84: 275–80

    CAS  PubMed  Google Scholar 

  6. Cohen JA, Kaplan MM (1979) The SGOT/SGPT ratio — an indicator of alcoholic liver disease. Digest Dis 24: 835–8

    Article  CAS  Google Scholar 

  7. Daniel S, Ben-Menachem T, Vasudevan G, et al (1999) Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 94: 3010–4

    Article  CAS  PubMed  Google Scholar 

  8. De Ledinghen V, Combes M, Trouette H, et al (2004) Should a liver biopsy be done in patients with subclinical chronically elevated transaminases? Eur J Gastroenterol Hepatol 16: 879–83

    Article  PubMed  Google Scholar 

  9. De Ritis F, Coltori M, Giusti G (1972) Serum transaminase activities in liver disease. Lancet 1: 685

    PubMed  Google Scholar 

  10. Diehl AM, Potter J, Boitnott J, et al (1984) Relationship between pyridoxal 5′- phosphate deficiency and aminotrans-ferase levels in alcoholic hepatitis. Gastroenterology 86: 632

    CAS  PubMed  Google Scholar 

  11. Elinav E, Ben-Dov IZ, Ackerman E, et al (2005) Correlation between serum alanine aminotransferase activity and age: an inverted U curve pattern. Am J Gastroenterol 100: 2201–4

    Article  PubMed  Google Scholar 

  12. Ellis G, Goldberg DM, Spooner RJ, et al (1978) Serum enzyme tests in diseases of the liver and biliary tree. Am J Clin Path 70: 248–58

    CAS  PubMed  Google Scholar 

  13. Farre C, Esteve M, Curcoy A, et al (2002) Hypertransam-inasemia in pediatric patients celiac disease patients and its prevalence as a diagnostic clue. Am J Gastroenterol 97: 3176–81

    Article  CAS  PubMed  Google Scholar 

  14. Fraser A, Ebrahim S, Smith GD, et al (2007) A comparison of associations of alanine aminotransferase and gamma-glutamyltransferase with fasting glucose, fasting insulin, and glycated hemoglobin in women with and without diabetes. Hepatology 46: 158–65

    Article  CAS  PubMed  Google Scholar 

  15. Giannini EG, Testa R, Savarino V (2005) Liver enzyme alterations: a guide for clinicians. CMAJ 172: 367–79

    PubMed  Google Scholar 

  16. Goessling W, Friedman LS (2005) Increased liver chemistry in an asymptomatic patient. Clin Gastroenterol Hepatol 3: 852–8

    Article  PubMed  Google Scholar 

  17. Green RM, Flamm S (2002) AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 123: 1367–84

    Article  PubMed  Google Scholar 

  18. Gurakuqi GC, Stadlbauer V, Stepan V, et al (2006) Addison' s disease as a rare cause of chronically elevated liver enzymes. Z Gastroenterol 44: 179–83

    Article  CAS  PubMed  Google Scholar 

  19. Hay JE, Czaja AJ, Rakela J, et al (1989) The nature of unexplained chronic aminotransferase elevations of a mild to moderate degree in asymptomatic patients. Hepatology 9: 193–7

    Article  CAS  PubMed  Google Scholar 

  20. Hulcrantz R, Glaumann H, Lindberg G, et al (1986) Liver investigation in 149 asymptomatic patients with moderately elevated activities of serum aminotransferases. Scand J Gastroenterol 21: 109–13

    Article  Google Scholar 

  21. Ioannou GN, Weiss NS, Boyko EJ, et al (2005) Contribution of metabolic factors to alanine aminotransferase activity in persons with other causes of liver disease. Gastroenterology 128: 627–35

    Article  CAS  PubMed  Google Scholar 

  22. Ioannou GN, Boyko EJ, Lee SP (2006) The prevalence and predictors of elevated serum aminotransferase activity in the United States in 1999–2002. Am J Gastroenterol 101: 76–82

    Article  PubMed  Google Scholar 

  23. Kamath PS (1996) Clinical aproach to the patient with abnormal liver test results. Mayo Clin Proc 71: 1089–96

    Article  CAS  PubMed  Google Scholar 

  24. Kew MC (2000) Serum aminotransferase concentration as evidence of hepatocellular damage. Lancet 355: 591–2

    Article  CAS  PubMed  Google Scholar 

  25. Kim HC, Nam CM, Jee SH, et al (2004) Normal serum ami-notransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ 328: 983

    Article  CAS  PubMed  Google Scholar 

  26. Klatsky AL, Morton C, Udaltsova N, et al (2006) Coffee, cirrhosis, and transaminase enzymes. Arch Intern Med 166: 1190–5

    Article  PubMed  Google Scholar 

  27. Kundrotas LW, Clement DJ (1993) Serum alanine amin-otransferase (ALT) elevation in asymptomatic US Air Force basic trainee blood donors. Dig Dis Sci 38: 2145–50

    Article  CAS  PubMed  Google Scholar 

  28. Liangpunsakul S, Chalasani N (2005) Unexplained elevations in alanine aminotransferase in individuals with the metabolic syndrome: results from the third National Health and Nutrition Survey (NHANES III). Am J Med Sci 329: 111–6

    Article  PubMed  Google Scholar 

  29. Lo Iacono O, Petta S, Venezia G, et al (2005) Anti-tissue transglutaminase antibodies in patients with abnormal liver tests: is it always coeliac disease? Am J Gastroenterol 100: 2472–7

    Article  PubMed  Google Scholar 

  30. Madan K, Batra Y, Panda SK, et al (2004) Role of poly-merase chain reaction and liver biopsy in the evaluation of patients with asymptomatic transaminitis: implications in diagnostic approach. J Gastroenterol Hepatol 19: 1291–9

    Article  PubMed  Google Scholar 

  31. Mendes FD, Levy C, Enders FB, et al (2007) Abnormal hepatic biochemistries in patients with inflammatory bowel disease. Am J Gastroenterol 102: 344–50

    Article  PubMed  Google Scholar 

  32. Moreno A, Carreno V, Cano A, et al (1997) Idiopathic biliary ductopenia in adults without symptoms of liver disease. N Engl J Med 336: 835–8

    Article  CAS  PubMed  Google Scholar 

  33. Nathwani RA, Kumar SR, Reynolds TB, et al (2005) Marked elevation in serum transaminases: an atypical presentation of choledocholithiasis. Am J Gastroenterol 100: 295–8

    Article  CAS  PubMed  Google Scholar 

  34. Pendino GM, Mariano A, Surace P, et al (2005) Prevalence and etiology of altered liver tests: a population-based survey in a Mediterranean town. Hepatology 41: 1151–9

    Article  PubMed  Google Scholar 

  35. Pourshams A, Malekzadeh R, Monavvari A, et al (2005) Prevalence and etiology of persistently elevated alanine ami-notransferase levels in healthy Iranian blood donors. J Gastroenterol Hepatol 20: 229–33

    Article  PubMed  Google Scholar 

  36. Prati D, Taioli E, Zanella A, et al (2002) Updated definitions of healthy ranges for serum alanine aminotransferase levels. Ann Intern Med 137: 1–10

    CAS  PubMed  Google Scholar 

  37. Pratt DS, Kaplan MM (2000) Primary care: evaluation of abnormal liver -enzyme results in asymptomatic patients. N Engl J Med 342: 1266–71

    Article  CAS  PubMed  Google Scholar 

  38. Ruhl CE, Everhart JE (2003) Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology 124: 71–9

    Article  CAS  PubMed  Google Scholar 

  39. Ruhl CE, Everhart JE (2003) Relation of elevated serum alanine aminotransferase activity with iron and antioxidant levels in the United States. Gastroenterology 124: 1821–9

    Article  CAS  PubMed  Google Scholar 

  40. Ruhl CE, Everhart JE (2005) Coffee and caffeine consumption reduce the risk of elevated serum alanine aminotransferase activity in the United States. Gastroenterology 128: 24–32

    Article  CAS  PubMed  Google Scholar 

  41. Ruhl CE, Everhart JE (2005) Joint effects of body weight and alcohol on elevated serum alanine aminotransferase in the United States population. Clin Gastroenterol Hepatol 3: 1260–8

    Article  CAS  PubMed  Google Scholar 

  42. Seidel D, Gretz H, Ruppert C (1973) Significances of LP-X test in differential diagnosis of jaundice. Clin Chem 19: 86–90

    CAS  PubMed  Google Scholar 

  43. Skelly MM, James PD, Ryder SD (2001) Findings on liver biopsy to investigate abnormal liver function tests in the absence of diagnostic serology. J Hepatol 35: 185–9

    Article  Google Scholar 

  44. Skrede S, Solberg HE, Blomhoff JP (1978) Bile acids measured in serum during fasting as a test for liver disease. Clin Chem 24: 1095–9

    CAS  PubMed  Google Scholar 

  45. Sonzogni A, Colloredo G, Fabris L, et al (2004) Isolated idiopathic bile ductular hyperplasia in patients with persistently abnormal liver function tests. J Hepatol 40: 592–8

    Article  PubMed  Google Scholar 

  46. Stranges S, Dorn JM, Muti P, et al (2004) Body fat distribution, relative weight, and liver enzyme levels: a population-based study. Hepatology 39: 754–63

    Article  PubMed  Google Scholar 

  47. Thomas L, Stein W (1998) Enzyme. In: Thomas L (ed), Labor und Diagnose. Indikation und Bewertung von Laborefunden für die medizinische Diagnostik, 5th. edn, TH-Books Verlagsgesellschaft, pp. 29–102, Frankfurt/Main

    Google Scholar 

  48. Torezan-Filho MA, Alves VA , Neto CA, et al (2004) Clinical significance of elevated alanine aminotransferase in blood donors: a follow-up study. Liver Int 24: 575–81

    Article  CAS  PubMed  Google Scholar 

  49. Van Ness MM, Diehl AM (1989) Is liver biopsy useful in the evaluation of patients with chronically elevated liver enzymes? Ann Int Med 111: 473–8

    PubMed  Google Scholar 

  50. Volta U, De Franceschi L, Lari F, et al (1998) Coeliac disease hidden by cryptogenic hypertransaminasaemia. Lancet 352: 26–9

    Article  CAS  PubMed  Google Scholar 

  51. von Herbay A, Strohmeyer G (1994) Die erhöhte gamma-GT — Ursachen und Interpretationen. Dtsch med Wschr 119: 1041–4

    Article  Google Scholar 

  52. West J, Brousil J, Gazis A, et al (2006) Elevated serum alanine transaminase in patients with type 1 or type 2 diabetes mellitus. QJM 99: 871–6

    Article  CAS  PubMed  Google Scholar 

  53. Whitehead MW, Hawkes ND, Hainsworth I, et al (1999) A prospective study of the causes of notably raised aspartate aminotransferase of liver origin. Gut 45: 129–33

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Chair, Department of Medicine II, Klinikum Offenbach, Goethe University Frankfurt/Main, Starkenburgring 66, Offenbach, 63069, Germany

    Henryk Dancygier (Professor of Medicine)

  2. Department of Medicine, Division of Liver Diseases, Mount Sinai School of Medicine, New York, NY, USA

    Henryk Dancygier (Professor of Medicine)

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, UMDNJ-Robert Wood Johnson Medical School, One Robert Wood Johnson Place-MEB 478, New Brunswick, NY, 08903, USA

    Jason N. Rogart (Assistant Professor of Medicine)

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Dancygier, H., Rogart, J.N. (2010). Approach to the Patient with Abnormal Liver Enzymes. In: Clinical Hepatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-93842-2_49

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  • DOI: https://doi.org/10.1007/978-3-540-93842-2_49

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-93841-5

  • Online ISBN: 978-3-540-93842-2

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