elevated liver enzymes

Hello - thanks for asking your question.

It appears you have been evaluated thoroughly with a liver biopsy and physicians at the Mayo Clinic.  I will give information on elevated liver enzymes, but please understand that I cannot diagnose you over the internet.  

There are many reasons that can cause elevated liver enzymes.

Medications — Almost any medication can cause an elevation of liver enzymes. Common ones include nonsteroidal anti-inflammatory drugs, antibiotics, HMG-CoA reductase inhibitors, antiepileptic drugs, and antituberculous drugs.

Alcohol abuse - In a study of hundreds of patients who had liver biopsy confirmed liver disorders, more than 90 percent of the patients whose AST to ALT ratio was two or greater had alcoholic liver disease.

Hepatitis

Hereditary hemochromatosis — Hereditary hemochromatosis (HHC) is a common genetic disorder. Population screening has shown that the frequency of heterozygotes is about 10 percent in Caucasian populations in the United States and western Europe, with a frequency of about 5 per 1000 (0.5 percent) for the homozygous state.

Hepatic steatosis and steatohepatitis — Hepatic steatosis and an associated condition, non-alcoholic steatohepatitis (NASH), may present solely with mild elevations of the serum aminotransferases, which are usually less than fourfold elevated.

Muscle disorders — Elevated serum aminotransferases, especially AST, may be caused by disorders that affect organs other than the liver, most commonly striated muscle.

Thyroid disorders — Thyroid disorders can produce elevated aminotransferases by unclear mechanisms.

Celiac disease — Several reports have described elevated serum aminotransferases in patients with undiagnosed celiac disease.

Adrenal insufficiency — Aminotransferase elevation (1.5 to 3 times the upper limit of normal) has been described in patients with adrenal insufficiency (due to Addison's disease or secondary causes), including those without obvious clinical features of the disorder.

Autoimmune hepatitis — Autoimmune hepatitis (AIH) is a condition found primarily in young to middle-aged women. The diagnosis is based upon the presence of elevated serum aminotransferases, the absence of other causes of chronic hepatitis, and features (serological and pathological) suggestive of AIH.

Wilson's disease — Wilson's disease, a genetic disorder of biliary copper excretion, may cause elevated aminotransferases in asymptomatic patients.

Alpha-1-antitrypsin deficiency — Alpha-1-antitrypsin deficiency is an uncommon cause of chronic liver disease in adults.

As you can see there are several non-liver disease that can cause elevated liver enzymes as well.  These are some possibilities you may want to present to your personal physician for further evaluation.

I strongly suggest followup with your personal gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.