Elevated SGPT and SGOT

[balanced_percept]

About three months back I discovered accidental that my liver enzymes were quite elevated. My SGPT was 256 and SGOT was 143. I don't remember having any particular symptoms but I have had digestion problems on and off as I used to binge eat a lot and I am quite overweight. I consulted a specialist, he tested me for HCV and HBV which came back negative fortunately. He then did an ultrasound scan and said that I had a fatty liver. He advised that I should take some supplements and try to lose weight. He said that my liver enzymes would be normal if I lost around 25 kgs. I was scared and I started to diet strictly.

I tested about two weeks later and my SGPT was 194, SGOT was 102, Serum Alkaline Phosphatase 149 and Gamma 95. My Direct Bilirubin was 0.16, Indirect was 0.25 and Total was 0.41.

I felt a bit relaxed and started binging again. I then tested again after a month and a half and my report was SGPT: 228, SGOT: 111, Phosphatase: 179 and Gamma: 119. DIrect Bilirubin was 0.10, Indirect was 0.51 and Total was 0.61.

Now I am on diet again. But I have constant fluctuating body temperature which usually rises after slightly physical strain or even eating. It goes back to normal when I rest in a cold room temperature. My doctor says it has nothing to do with my liver, but I think I have heard somewhere that high levels of SGPT can cause mild fever (I am not too sure though).

My another worry is: Should I test for HCV and HBV again, as I have heard that recent infection doesn't show up on tests for sometime. But then I am not sure if an undetectable infection can cause such serious harm to the liver.

I would be grateful if someone could advise.

[vikraaditya]

i was detected with hepatitis E three months back when sgpt was around 235 and bilrubin normal .. it had been continously deccreasing since then till fifteen days back my sgpt came down to 45 .
Today again i tested and found sgpt got elevated to 70 and bilrubin also rose but very minimal,
Please suggest

[mikesimon]

If I were you I wouldn't worry about hep b or c - unless you believe you may have been exposed very recently. Hep c is transmitted by blood to blood exposure and usually we'd know about a risk. Generally the initial test for hep c is an antibody test and antibodies to hep c can take a month or longer before they are detectable. A PCR / NRA test can detect the active virus sooner - in a week or 2 - but unless you're are worried about a very recent exposure I would relax about either of those 2 infections.
I think diet and perhaps the vitamin e and/or pioglitazone are the things to concentrate on - if your doctor thinks the E and/or pioglitazone are safe and worthwhile, that is.

Good luck,
Mike

[balanced_percept]

Thank you very much for your reply. I am really grateful to you for this "Since you tested negative while your enzymes we elevated I do not think that is the cause." This has caused a great relief.

By the way I have tested three times for both Hep C and Hep B in the last three months and all the three tests came back negative while my enzymes were found elevated every time. Do you think I should stop testing for Hep C and B and just focus on losing weight and dealing with my fatty liver?

I am certainly going to discuss with my doctor what you mentioned regarding vitamin e and the other medicine.

Thanks again.

[mikesimon]

Cirrhosis of the liver is not always terminal. There are people who die with cirrhosis and not from cirrhosis. There are different stages of cirrhosis but in broad terms there is compensated cirrhosis and decompensated cirrhosis. Decompensated cirrhosis describes a condition where the liver is no longer performing its function and this is terminal unless one has a liver transplant. With compensated cirrhosis the liver still performs its basic functions. People can liver with compensated cirrhosis for a long period of time.
It has been believed that liver cirrhosis was irreversible. Lately, however, there is evidence that in some cases liver cirrhosis can be reversed. For example patients who eradicate the hepatitis c virus can have an improvement in liver histology - reverse some damage. I believe the improvement can be 1 stage or possibly 2 so a person with cirrhosis might improve to stage 3 fibrosis if they eradicated the hepatitis c which cause the liver damage.

I hope I have shed some light on your questions.

Mike

[quirkey]

I have cryptogenic cirrhosis of the liver they do not why. I do not drink at all now but the odd(I mean odd) vodka in the year 20 40year before like any young person a few more.  I go for ultra scan every 6 months to check its no worse as it will not repair itself.  I have to increase my protein which is hard as I am not a great meat eater, allergic to eggs do not like fish other than cod.  I am to overweight try to loose but find it hard as I like sweet .  Can someone tell me the truth is Liver cirrhosis terminal as it cannot be cured

[mikesimon]

Since you tested negative while your enzymes we elevated I do not think that is the cause. I think you have a fatty liver and yo did see a drop when you stopped binging. I think you should lose weight which has been the only approach to fatty liver.
Recently there have been some studies which suggest that vitamin e and a diabetic drug may also help reverse some of the effects of fatty liver. I don't think that presently either of these 2 are being routinely prescribed but it is something you could discuss with your doctor.

Here is one article discussing vitamin e and pioglitazone.

"Vitamin E, diabetes drug may reverse fatty liver disease

Test results in obese people suggest treatments for common cirrhosis precursor
By Nathan Seppa
Wednesday, April 28th, 2010

Taking either vitamin E or a diabetes drug can reverse the course of fatty liver disease, a condition sometimes associated with obesity, researchers report online April 28 in the New England Journal of Medicine.

The findings come as welcome news for people who are prone to getting the disease, which can lead to cirrhosis and irreversible liver damage if fat accumulation in the liver goes unchecked. There is currently no established treatment for the condition other than to lose weight.

Fatty liver is a silent disease that’s typically diagnosed from aberrant liver enzyme scores on blood tests. Often the patient feels nothing, says hepatologist Arun Sanyal of Virginia Commonwealth University School of Medicine in Richmond.

Earlier studies had suggested that both vitamin E and the diabetes drug pioglitazone could benefit people with fatty liver disease. Doctors sometimes even prescribe pioglitazone off-label for the condition, Sanyal says.

To test the effectiveness of pioglitazone and vitamin E, Sanyal and colleagues at 11 other medical facilities identified 247 people who had severe fatty liver disease. None of the volunteers drank alcohol excessively or was diabetic, but all were overweight or obese. Their average age was in the mid-40s.

The researchers randomly assigned participants to one of three treatments —  vitamin E, pioglitazone or a placebo capsule — taken daily for nearly two years. Each volunteer underwent a liver biopsy at the beginning and end of the trial.

Biopsies revealed that 43 percent of the vitamin E group showed substantial improvement, based on a composite score of liver tissue characteristics, as did 34 percent of people receiving pioglitazone and 19 percent of those on placebo. The improvement among people getting fake pills wasn’t a surprise, Sanyal says, because “when people enter clinical trials, they typically behave themselves.”

While the pioglitazone and placebo groups’ percentages were only marginally different from one another, the biopsy data also revealed that the drug — like vitamin E — substantially lessened liver inflammation, fat accumulation and the presence of dying “ballooning cells” that appear in fatty liver tissue.  

“This confirms a long-term benefit for pioglitazone and gives an alternative option” in the form of vitamin E, says Kenneth Cusi, an endocrinologist at the University of Texas Health Science Center at San Antonio.

Pioglitazone improves insulin signaling, which helps people with diabetes metabolize sugar. But the drug’s effects may also extend to diminishing the amount of fat in the liver, Cusi says.

Vitamin E is an antioxidant that sops up free radicals and prevents these unstable molecules from damaging cell membranes.  As such, the vitamin would seem tailor-made to protect against any number of diseases.

But vitamin E has yet to fulfill this promise. “There are no clearly proven medicinal uses of vitamin E,” states the Mayo Clinic website. It has failed to protect against heart disease in trials, and in one case even seemed  to slightly increase subjects’ risk of dying.

“It’s too early to recommend [vitamin E] as a panacea” for fatty liver disease, Sanyal says. Whether to recommend it to patients will be up to doctors.

Meanwhile, he and his colleagues are investigating the biological mechanisms by which vitamin E or pioglitazone might reverse fatty liver disease. Cusi’s research group is testing pioglitazone against fatty liver in Hispanics, who seem prone to the disease, and in people with diabetes."

http://tinyurl.com/26n7s8s

Mike