Elevated Liver Enzymes

[caplanr]

I have Crohns disease which is under good control using Imuran (on it for one and a half years) and remicade (on it for a year). I have always had normal liver enzyme tests. However i recently got a test back with my AST at 514 and my ALT at 170. My ALK Phosphate was 159. My bilirbin was normal as was my albumin and total protein.

Could this elevation be due to over excercising? or are levels not seen that high traditionally from muscle damage or injury?

Also, if bilirubin is normal, is it less likely that the increase in the AST is due to some viral disease such as hepatitis b/c?

Could it be a false positive or is that unusual?

thanks

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note elevated liver enzymes.  There are several considerations.

First are your medications.  Both the Imuran and Remicade are associated with hepatitis and elevated liver enzymes.  I would suggest that you discuss with your personal physicians about the possible effects of the medications on your liver enzymes.

If that is non-revealing, then the causes can also include hepatitis, alcohol, fatty or rarer diseases such as hemochromatotis or Wilson's disease.  

I would suggest a hepatitis screen and abdominal ultrasound (looking for liver masses or fatty liver).  Tests for hemochromatosis (with ferritin and iron studies) or Wilson's disease can also be considered.

But as I said before, the first consideration would be the Imuran and Remicade.  

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.

[kimbacat]

have you repeated the tests after you've lowered the Imuran dose or taken a short break from it?  that could help you figure out if it's the Imuran (the more likely culprit) and is what my doc usually does first.  I was on Imuran for 4 yrs and am now on methotrexate and Remicade for Crohn's.

good luck