Elevated ALT and GGT again, Ultrasound fine, what next?

I've had raised ALT and GGT off and on for a few years.  In January I had ALT of 65 and GGT 110  (these aren't much over the high reference ranges of the lab)  I then completely abstained from Alcohol but was put on proton pump inhibitors for reflux.  The doctor thought it was alcohol even though my AST is normal. I have remained completely abstainent and have been tested each month since then and my results have started to go up peaking at ALT 130 and GGT 195. I had some URQ pains but these might be due to the reflux.  I ate large amounts of fatty food the night before the tests because the doctor seemed to believe that would have no affect.  I was also tested for Hep A/B/C and kidney problems, all results were normal.

I went for an ultrasound today and was told the ultrasound showed everything to be perfectly normal.  

Can you have these elevated enzymes for years without damage? Everything I read seems to suggest I'm going to end up with fibrosis and then cirhosis if this isn't stopped and it seems if I can't stop the damage through not drinking then there isn't a very good prognosis and no treatment.

The doctor referred me for an ultrasound because she thought that the cause might not be alcohol.  What else could it be if the ultrasound is normal with no fatty liver?  My son has multiple food allergies and I wondered if I was allergic to something and that might be causing this as I've never been aware of any allergies but my family have various allergies to diary and wheat, etc.  My Grandmother also had type 2 diabetes and I am about 2 stone overweight and have done almost no exercise for 4 years.  Could this be the early stages of diabetes?

Should I be pushing to have a biopsy or fibroscan? (The GI specialist seemed reluctant to perform biopsy a few years ago when I was refered, due to the risks.)  

[Kevin Pho, MD]

I agree with the ultrasound being the initial test.  A negative study would exclude many of the major liver causes.

A liver biopsy is typically recommended when the enzymes are approaching three times the upper limit of normal.  Yours are around that level.  So, in addition to blood tests to exclude viral hepatitis, you may want to consider the biopsy to more definitively exclude iver disease.

This option should be discussed with your GI physician.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd