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Gastroenterology (Expert Forum)
Mild elevations in 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.
Mild elevations in ALT
by osiag, Apr 08, 2006 12:00AM
I’m 37 otherwise healthy male. Been getting a full blood work up w/ UA every 6 -12 mos for the last 7 yrs routinely. On 3 occasions, ALT had been 41-45 while I taking or w/in a mo. of taking a prescript drug eg, antibiotics or ambien. On follow up, ALT has always returned to norm w/in 4-6 wks of stopping meds. GP wasn’t very concerned, but I saw a gastro dr. Here is a synopsis of testing over the last 4 yrs. Viral tests: I have very low to no risk factors. I’ve been vaccinated for A & B. I no longer have the surface anti-B for HBV, though. However, I’ve been tested 2X for HBV – both neg. Tested for HCV 3X – all neg. Iron test from 4 yrs ago: sat -79%, serum iron – 248 & ferritin -93. Shortly, after everything was norm. Since then, ferritin has been 65 – 135. Here are iron sats since then in order: 39, 30, 10, 14, 26, 28, & 30. Fatty liver tests: recent sonogram – norm. Routinely, my glucose is under 90, tris are under 100, total cholest 140-165. Auto-immune tests: I’ve tested negative for Abs: anti-smooth muscle cell, anti-mitochondrial, & ANA. Ceruloplas was 21 (normal – 18-36) & alpha-1-antitrypsin was 110 (normal – 93-199). UA always norm.
My very recent ALT = 44 & I’ve been no meds for 7 + wks & no alcohol for 4 wks. This is the 1st time that I cannot pin ALT to anything recent. On same test everything else is normal. Since we are doing IVF, I was just tested neg. again (it’s a law) for HBV, HCV, RPR, & HIV. Dr says it may just be that ALT fluctuates between 25 -45. Albumin = 5.2. I won’t have a biopsy. Dr says forget this all. Short of a biopsy, is there anything else?
My very recent ALT = 44 & I’ve been no meds for 7 + wks & no alcohol for 4 wks. This is the 1st time that I cannot pin ALT to anything recent. On same test everything else is normal. Since we are doing IVF, I was just tested neg. again (it’s a law) for HBV, HCV, RPR, & HIV. Dr says it may just be that ALT fluctuates between 25 -45. Albumin = 5.2. I won’t have a biopsy. Dr says forget this all. Short of a biopsy, is there anything else?
Doctor's Answer
by Kevin Pho, MD, Apr 10, 2006 12:00AM
, Apr 10, 2006 12:00AM
You have had a pretty comprehensive evaluation already. Most physicians won't consider a biopsy unless the liver enzymes are three times the upper limit of normal. Your ALT is clearly below that.
That being said, I cannot think of any other testing that could evaluate the liver - short of a biopsy. Many of the major liver diseases would have already been ruled out with the testing you have had.
You can always consider another opinion with a hepatologist.
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.
kevinmd_b
That being said, I cannot think of any other testing that could evaluate the liver - short of a biopsy. Many of the major liver diseases would have already been ruled out with the testing you have had.
You can always consider another opinion with a hepatologist.
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.
kevinmd_b
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