HELP! Newbe with high liver enzymes.

[fish22]

First, "Happy Holidays" to all, and most importantly, have a safe one at that...Enjoy!!!

I'm a 50 year old male in my 35th week of a 48 week Treatment Protocol (Peginterferon alfa 2a/Ribavirin) and my ALT/AST Liver enzymes are still elevated--between 200-250--despite my viral load (3a) being undetected for some time.  My doc is puzzled as I am??  He has been checking me out for other causes (autoimmune, etc.) but so far, all tests have come back negative.    

I do carry a single gene mutation C282Y for Hemochromatosis but apparently he doesn't think this is the culprit.  He said something is causing this other than HEP C??  My ferritin blood levels are above 2000 and my iron is somewhat elevated as well.  

Liver BX results: September 1998.  HAI Score: Portal inflammation--1,  Lobular inflam...1,  Piecemeal Necrosis--1.  Total score 3.

Liver BX results: April 2004.  Same as above but Fibrosis score was 0-1/6.

Liver BX results: March 2007.  Same as above except Portal inflammation is now--2.  Total score 4.  Also, Fibrosis score is now 1/6.  Iron deposites were minimal.

Has anyone ever had a similar problem or been in a similar situation?  Also, does anyone have any idea or clue as to what might be causing the elevation in liver enzymes?  I appreciate your thoughts on this...

Note:  I've had HEP C for well over 20 years and had 26 weeks of treatment (Interferon alfa 2b/Ribavirin) back in 1999 but had to quit due to side effects.  Anyhow, I did relapsed.  I just started new treatment on 4/22/07 with Peg Inter...2a but back in 12/2006 (before treatment) my liver enzymes were beginning to elevate then, and my viral load count all of a sudden skyrocketed between 12/06 and pretreatment blood work in 3/07???  As of this writing, enzymes are still hoovering between 200-250.  

Lastly, I recently read an article on Chronic active and Chronic persistent Hep C and a liver biopsy may not be as accurate--depending on which one of these a person has.  It went on to say that sometimes liver damage could be worse in other parts of the liver and a biopsy wouldn't pick up on this if taken from a different part of the liver.  Damage may not be equally distributed???  Worth mentioning that my liver biopsy from September 98 also noted that they though I might of had beginning stages of cirrosis, but couldn't be sure due to whether the biopsy was subscapular or something like that.  Then again, this biopsy was done manually--right side (no US guided and took 2 attempts) by a Doctor, whereas my following 2 BX's were done on my stomach by a Tech (US guided).  Hey, it is what it is, but surely would like to find a diagnosis for I don't think my problem lies above--as mentioned.

Peace.  

fish22      


      

[fish22]

Hi Jody,

I also have arthritis, and Hep C treatment seems to only make it worse.  Regarding your brother, a very sad thing to have to go through anytime, but probably more so around the holidays...From my own personal experiences, it was more painful to witness my father slowly decline then his passing.  Only then was he at peace.  No one can feel your pain as you do...God bless you and loved ones.

PEACE.      

[Jody515]

Fish,
I found it amazing also that nothing of that nature showed up in blood for so long as to the HCV & the AIH.  The first Dr I was seeing was a gastro & he said it was not unusual for the HCV to not show up for long period of time just as HIV doesn't.  As far as the HCV goes, when my husband went to Dr for annual in summer of either 2000 or 2001, he noticed the tatoos on him & asked when he got them & he told him over in Nam.  So the Dr tested & came bk positive which of course sent me straight to Dr.  That is when the HCV showed up, but I discussed with him all the other types of health issues & all the auto immune diseases in the family but he stated that had nothing to do with me.  When he had the biopsy done, that is when the true facts came out.Thanks much for your concern,it is greatly appreciated but I am feeling better & with the meds for the AIH, the other health issues dissapated.  (bad upper body arthritis mainly). I don't believe my brother will be with us much longer & for that I am really sad.  Thanks again, Jody

[fish22]

Hi Jody,
Sorry to hear you have both HCV and AIH.  Also, it's amazing how nothing showed up on your tests until later on...  This has me thinking???  After reading your post, I realize that years ago I had HEP A and was a heavy drinker.  Definitely something I'll have to look into.  Thanks for your help and hope everything goes well with you and many blessings for your brother.
Happy Holidays
Peace

Hi medicmommy,
First, I'm glad you BX only showed stage 1 and enzymes are normal.  I'll look into those other things you've mentioned.  My Doc, although a good man, seems not to be with it...long story.  This is why I most likely will seek a 2nd opinion.  I have 13 weeks left of treatment and maybe my results will get better??  As a matter of fact, I just got back from the Doc and my ALT decreased from 227 to 190.  I didn't get the AST level but it was at 181.  I did test positive for ASM but was told nothing to worry about because the ASM Titer was only 1:20--whatever that means.  My AFP was a little high--at 8.6 (0.0 - 7.7).  As they say, to be continued...

I think my Doc is both a GI and Hepatologist???  
Thanks for your help!
Happy Holidays
Peace.

    

[medicmommy]

also...Is your doc a hepatologist or just a GI doc? I've found a liver doc to be more informed about this sort of thing...

[medicmommy]

Hello!
I was wondering...I too had a lap liver bx...But I also had my gallbladder out at the same time...It was the culprit in causing my enzymes to be persistently elevated as it was causing a "backup" into my liver...(My bx came back as stage 1, grade 1) Since then, my enzymes have been rock solid good...Maybe what's going on with you is a bile duct issue...It is common in heppers (and non heppers too) with persistent enzyme elevations...Check out cholecystitis and cholangitis symptoms...Good luck!

[Jody515]

Don't want to worry you but just had to let you know from my own experience with the liver.  I juandiced from head to toe in 1997 & went to my family doctor who thought I had Hep A.  All Hep tests were given, enzymes were off the chart with nothing showing.  This went on from July thru Feb with all forms of Hep tests given to me at least every 6 wks.  Nothing showed.  At least 4 yrs went by, and unexplainable health issues starting coming up.  Again, enzymes rose, & blood test finally showed hcv and nothing else.  However biopsy which traveled all the way to the Mayo Clinic thru 2 other sources finally came bk that I was a rarity with AIH also & that was causing the tremendous amount of damage to liver, more so then the hcv.  Since you are a male, chances are slimmer that you could have this, but it is not impossible. Nothing in my blood work showed though as far as the auto immune issue.  I have a brother with a similar problem, in liver failure & nothing showed up in blood work but the biopsy told the story.  Good luck to you & Happy Holidays.  Jody

[fish22]

Frijole, you're right, I meant "newbe to this forum".  They didn't do any pictures of my liver; just the normal routine liver biopsies.  By the way, I looked for that website about the differences between chronic active and chronic persistant regarding liver bx and didn't find it, yet.  I'll keep looking and will get back to you if and when I do.  The article is not only informative, but also interesting and is something we might all want to read.  I did hear about spikes in enzyme levels during treatment, but unfortunately mine were already rising before treament and as such, not caused by the treatment itself???

Good luck on your biopsy results.  Hope it is good news.

Peace.

Happy Holidays!

  

[fish22]

Hey Rick, many thanks for your comments.  After treatment, if they still don't know what's up with me, I guess I'll go for a 2nd opinion.  I may even have to see a specialist in another area.  My next appt., with my Doc is tomorrow.  Hopefully they'll have some news from a urine test and additional blood work done last week.  I know whatever it is, it's attacking my liver.  I just want to find out what that something is.

I never heard of a Laproscopic BX but good to know there are other ways to assess the liver.  That sounds much more intense that my 1st biopsy, though...ouch!  Also, sorry to hear about your relapsing as well, but am happy that it did reverse prior damage to your liver. That's good news!!  Also, the best with round two...

Merry Christmas
PEACE

Tom  

[frijole]

fish22 - I first, you're no newbie if your on week 35, and your second treatment! -- maybe new to this forum.  Welcome.  I am frijole  - a relapser who treated 2005-06 and checks in frequently to see what is happening.  I thought spikes in liver enzymes were fairly average during treatment.  I am one of the rare breed whose enzymes were always in the normal range pre treatment (and after) - like in the low 20s.  However, during treatment, my enzymes reached the high 20s and 30s regularly.  I don't think there is anything to be alarmed about at all.   It sounds like you are doing well

A word or two on biopsies -- portal inflammation is the first stage.  Then the inflammation spreads to the lobes - which yours already had done some in 1998.  Necrosis, which means cell death, was evident -- I guess that is where the mention of cirrhosis comes in.  No mention of fibrosis (scarring) which is the precurser to necrosis?  Your second biopsy shows basically grade 1, stage 0-1 (or so -- all these grading elements are so different) so maybe your  1999 treatment slowed the progress.  Then your 2007 biopsy shows progress again - grade 2, stage 1.  Inflammation has increased and the scarring (fibrosis has increased).  No mention of necrosis -- good!

I believe biopsies can give you unclear readings because they can come from a part of the liver undamaged.  The article you read sounds interesting -- if it was on the Internet, can you give a link?  I just had a biopsy last Friday and the surgeon said he took samples from 3 lobes of the liver -- he said that should give them a good picture.  Hope so.  What did the pictures show you?  Have you compared that with pictures of healthy and unhealthy livers on the internet?  Curious.
frijole

Circus -- I was curious about your overnight stay for the laproscopic biopsy.  I mentioned that on another thread.  I too had a laproscopic biopsy last Friday.  I was home by 1:00.  I guess there are different kinds of laproscopic biopsies.  I don't think there were any pictures done in mine. -- just cores and wedges.  I don't have the results yet, but am expecting a good report.   Hope I am not surprised.

[CIRQDUSOLIEL]

We're sorry to hear that you are and had to deal with this!  Sorta of mixed emotions as well as blessings in that overall you're, if I read this correctly, are UND.  Well I can't believe that I am saying this after I posted just a few days ago about biopsy's.  However, and although they certainly are no fun, they, to my understanding of them, are a good standard to access the true condition of the liver.  I, on the other hand, just had a LAPROSCOPIC BIOPSY done where they not only sitck a needle in to remove a piece of your liver, but they, before the procedure is finished, also place inside you a camera to actually take a look at the liver.  I got my results back in two days, but I also had it done a the University of Miami, a teaching school.  They showed me the liver the next day from the pictures taken before releasing me from my overnight stay in the hospital.  They show you picture by picture ( for me seven in all )  and explained just exactly what you are looking at.  It was painful, but was it worth it?  Now you bet.......althought treatment didn't work for me this time round, doing this year of it did reverse the minimal damage that was done previously.  I will be giving my body a rest for some time to recoup and then I'll be getting right back in the saddle to go for round two.  Just thought I would comment on the biopsy part of your post to give you some insight for future reference that you might want to ask your Dr to consider doing  to get a better accessment the next time.  Take care, and Merry Christmas!

Yours in Christ,
Rick