Elevated AST?ALT results

I am a healthy 48 years old woman.  Since my first blood test 16 years ago, I have had elevated AST/ ALT results.  Both are only mildly above the range-only a few points.  2 years ago, my doctor sent me for a liver sons, which was negative. Same thing last month.  Hepatitis tests also negative.   Now she has referred me to a gastroenterologist, who wants blood tests for iron, ferritin, and fatty liver.  He says if the tests are negative, he wants to do a liver biopsy.  Naturally, I am not anxious to have what I consider a very invasive test if it is not necessary.  I am wondering what would be found on biopsy that would not show up on the blood work? Also, why couldn't we repeat the blood work to monitor my condition?  I have heard that  there are a certain percentage of cases where a cause can never be found. What percentage of cases fall into this category? How much more testing is necessary  before we decide that this is my case?

[Kevin Pho, MD]

The liver biopsy would be the definitive test that can find out if there is disease in the liver.  There are a variety of diseases that can be found on the biopsy that would not be present on the blood work or ultrasound.  

With the AST/ALT only being a few points above normal, it would certainly be reasonble to observe the levels.  Typically, the liver biopsy is indicated for AST/ALT levels 3-fold normal.  You may want to inquire about a second opinion to see if the biopsy is really necessary.  

It is certainly true that there is a percentage of cases where no clear cause is found.  Some studies report this to be around 5 percent.

As for further testing, I would say that if the liver biopsy is negative, that should be the end of the evaluation.  This however should be discussed 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.

Thanks,
Kevin, M.D.

[MRH]

I forgot to add to my question that my results have varied little over the course of the years, and my cholesterol has stayed about the same, about 190ish. It was up at one point to 220, but right back down again when I watched my diet. I am still wondering if monitoring the blood tests would be sufficient.  Even if I had the type of fatty liver which can lead to cirrhosis, wouldn't the results start to elevate in enough time to help stop the progression of the disease. Is a biopsy really that crucial?

[roxnsox]

A biopsy is the best way to find out exactly what is wrong with the liver.   I am a little older than you and have Non-alcoholic Steatohepatitis (NASH).  I have had 2 biopsies.  It only takes the doctor 5 minutes to do the biopsy and then you have to lay on your side for 2 hours.  It is really easy.  It is easier than a colonoscopy.  

  I had the slightly elevated liver enzymes for years and years.  My cholesterol results were about the same as yours.  

   Good luck.