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Gastroenterology (Expert Forum)
Elevated ALT
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Elevated ALT
by ec100, Aug 27, 2004 12:00AM
I am 32, 5'11" and weigh 185lbs. In Feb this year I visited my doctor with chest pains in the left side of my chest. I had an ECG which showed heart function & blood oxygen levels to be normal and a series of blood tests. These included Cholesterol and Liver Function Tests. The results showed my HDL Chol/HDL ratio to be slightly raised 5.08 (<4.5) but of more concern was elevated LFT results These included Total Protein 86 (63-82), Globulins 36 (17-35), Triglyceride 2.0 (0.4-1.8) and ALT 79 (<56). Prior to this test I had been taking antibiotics for acne (deoxycycline) and I stopped taking these and reduced alcohol intake to almost nothing. The tests were repeated one month later and Chol/HDL 5.2, Total Protein 85 and ALT 83. Other results had gone to normal. The elevated ALT level appeared to be the main cause for concern. I stopped drinking alcohol & caffine completely for one month prior to my third LFT tests which showed ALT at 86 and Albumin now to have raised to 53 (35-49) - four weeks prior to this test I was ill for 4 days with a fever. I was referred to a Gastroenterologist who ran a blood screen - within 3 weeks of the previous test - including hepatitis which was negative but ALT is now 93. I was then given an Ultrasound on my abdomen which showed everything to be essentially normal and no evidence of fatty infiltration of the liver. The Gastro has now suggested waiting for a further 2 months before re-running the LFT. He says he is hopeful that the LFT will have settled by then buf if not he may consider further investigations and in particular a liver biopsy.
I am a little confused about what all this means and while I understand that I don't appear to have Hepatitis and a fatty liver is unlikely I am not sure why the Gastro would expect that the ALT level may drop and what the likely cause would be? Alcohol consumption does not appear to affect this test and my diet is not particularly fatty and I rarely eat red meat or junk food. Also I am not keen on a liver biopsy as from what I have read my ALT levels - while raised - are not particularly high (< 2x normal) and this is rather an invasive test with some associated risks. Furthermore my original symptom (chest pain) have not been addressed... except for both my doctor and Gastro saying it is unrelated to the elevated ALT. I am concerned about my elevated ALT and what the possible cause might be, I am not clear on whether I can drink alcohol in moderation or whether this is a diet problem. I am also concerned about the chest pains which are dull and only on the left hand side of the chest.
Can you help me understand the thinking behind my Gastro's strategy and whether ordering a Liver Biopsy based on these numbers and my age is the right thing to do? Should I seek a second opinion, is the Gastro correct about the lack of link between my symptoms and the biochemistry? What is the likey cause of the raised ALT?
I am a little confused about what all this means and while I understand that I don't appear to have Hepatitis and a fatty liver is unlikely I am not sure why the Gastro would expect that the ALT level may drop and what the likely cause would be? Alcohol consumption does not appear to affect this test and my diet is not particularly fatty and I rarely eat red meat or junk food. Also I am not keen on a liver biopsy as from what I have read my ALT levels - while raised - are not particularly high (< 2x normal) and this is rather an invasive test with some associated risks. Furthermore my original symptom (chest pain) have not been addressed... except for both my doctor and Gastro saying it is unrelated to the elevated ALT. I am concerned about my elevated ALT and what the possible cause might be, I am not clear on whether I can drink alcohol in moderation or whether this is a diet problem. I am also concerned about the chest pains which are dull and only on the left hand side of the chest.
Can you help me understand the thinking behind my Gastro's strategy and whether ordering a Liver Biopsy based on these numbers and my age is the right thing to do? Should I seek a second opinion, is the Gastro correct about the lack of link between my symptoms and the biochemistry? What is the likey cause of the raised ALT?
Doctor's Answer
by Kevin Pho, MD, Aug 27, 2004 12:00AM
, Aug 27, 2004 12:00AM
This is not an uncommon scenario, an unexplained elevation in ALT. Hepatitis screen and ultrasound were negative. Typically, liver biopsy is considered if the ALT is persistantly 3x above the normal upper limit. Other things to consider would be more specialized diseases such as hemochromatosis or autoimmune hepatitis. They can be evaluated with more specific blood tests (i.e. iron studies, ferritin, ANA levels).
The liver biopsy would be the most thorough test, and can be considered if everything else remains negative.
As for the chest pain - you would want to ensure it isn't anything cardiac. Next step for evaluation would be an exercise stress test to evaluate for coronary artery disease.
You may want to discuss these options with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
The liver biopsy would be the most thorough test, and can be considered if everything else remains negative.
As for the chest pain - you would want to ensure it isn't anything cardiac. Next step for evaluation would be an exercise stress test to evaluate for coronary artery disease.
You may want to discuss these options with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
The physicians express that ELF is a bad thing...something is wrong. However, it also seems to be a mystery as to what is going on. What % of the general population has ELF? What happens to those with ELF? Will we have liver failure? There are several additional questions. Anyone else out there having similar questions/information?