Question Title: Chronic Hep B, liver function and Prilosec

2 years ago, I had an extensive liver work-up (sorry, no #'s available at the moment) including an ultrasound of my liver to determine if a biopsy was in order for further followup diagnosis. My specialist and the radiologist were both amazed that the liver surface was completely smooth with no signs of cirrochis (sp?) or diffusion, and while slightly enlarged, felt no further follow-up was needed at the time. My general hepatic function levels run a little high of course. My most recent tests show:

AST: 83 3/98 53 5/98 66 2/99
ALT: 67 3/98 50 8/98 55 2/99
Alkalkine Phosphatase: 146 3/98 168 5/98 211 2/99
Uric Acid: 3.5 L 3/98 2.5 L 5/98 6.0 N 5/99

Finally we're getting to the bottom line and my questions:

As of the 3/98 work-up, I was having horrible abdominal cramps around 2:00 AM, over a week or so, and according to a couple of "self-help" med ref books, then my PCP, appeared as fairly classic gallbladder problems, possibly a stone. Late heavy and or fatty meals seemed the primary trigger. My PCP recommended I see a surgeon for possible removal and placed me on Prilosec (20 mg)until then and/or the surgery. With the Prilosec, all symptoms vanished. I figured a high stress job may be a significant contributor to the condition, and not being in any hurry to have unnecessary surgery, I have stayed on the Prilosec to date and life is good. I have several times stopped (on my on) the drug for a few days to see what happens, but always the horrible heartburn gas and cramps return by the third day or so, and do not go away at night until vomiting occurs, so may need the gall bladder out (note: there has never been any sign of blood in vomit or stools, though vomit is heavy with bile)

The liver function levels of the last year shown above, are only slightly high, but the Alkaline Phosphatase continues a steady climb. No other panel functions are out of range, high or low.

To complicate, I also take zoloft for anxiety (100 mg) and periodically take ambien (1-2 tabs) for insomnia maybe 2 times a week. I know all three drugs are problematic on the liver.

From this general overview, can you offer:
1) any clarification on the Alkaline Phosphatase upward trend and what it relates to?
2) how problematic are the three drugs I'm taking, particularly the Prilosec, on my liver? Warning signs to look for?
3) any thoughts on the gallbladder that displays the unpleasant symptomologies, when I quit the Prilosec?

I ask, as I haven't seen a specialist in nearly 2 years since the "you're doing great" exam, as periodic changes in insurance coverage, PPO networks, etc., by employer creates chaos trying to always stay in network, causes me to switch docs, who then use different labs and want the benchmarks they are familiar with, and I cannot afford the hundreds and thousands of dollars to stick with a good doc and pay out of pocket. Sorry for the long email, but your insights will be greatly appreciated.

Well that’s a handful there. I’ll try to address some of your specific questions and make a few additional comments.

First of all, I feel I should tell you that an ultrasound is not a sensitive test of liver damage. While, I am happy that the contour of your liver is smooth with no “signs of cirrhosis”, you should appreciate that an ultrasound is not a sensitive test for cirrhosis. By the time, your liver is irregular from cirrhosis, this implies the cirrhosis is fairly advanced. We typically do not stop our evaluation of someone with hepatitis B with a negative ultrasound.

I can’t tell you for sure what to make of your alkaline phosphatase that is trending upwards except that it is worth watching and potentially looking into. The alkaline phosphatase can come from other places besides the liver and we can do tests on the alkaline phosphatase to see if it is coming from the liver and we can also test your blood for something called GGT. If the alk phos is coming from the liver, the GGT is usually elevated as well. If your alk phos is coming from the liver, it usually does imply something is going on with the liver and there is a long list of possibilities. Certainly your hepatitis B and possible gallstones are among the possibilities. Did they see any gallstones on your ultrasound?

Of the three drugs you are on, only zoloft causes liver enzyme abnormalities with any frequency. Both prilosec and ambien rarely cause liver enzyme abnormalities or liver problems.

You wonder if your symptoms could still be due to gallstones. Again, this is something that is difficult for me to comment on for sure without additional information. Again, you might want to ask your physicians if they saw gallstones on your ultrasound. However, if symptoms like the ones you describe respond to prilosec and come back when prilosec is stopped, typically they are not from gallstones. This would more likely suggest, they are due to problems of excess stomach acid because prilosec interferes with stomach acid production. Problems with stomach acid include ulcers, gastritis and acid reflux.

I hope this information is helpful to you. Please feel free to contact us if you have additional information or questions. If you are near Detroit, we would invite you to see us at Henry Ford. We have an active group of liver specialists with extensive experience with hepatitis B. You can always contact us directly at (313) 916-8865.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.