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AST elevation

Dear Dr,

Many thanks in advance for your help - apologies this is not a transplant question but I couldn't find another liver forum.

I'm 32 and over the last year my alcohol input has gone from heavy social to just heavy, largely due to personal difficulties - I probably drink 2-4 beers a night or 1/2-2/3 of a bottle of wine, and more on social occasions. All my friends are young professionals (I've a medical background) and we all drink too much when together - I know my drinking is unhealthy and have recently seeked counselling for my problems, and had aimed to cut back but think completely stopping would be incredibly difficult at this time due to ongoing family illnesses and troubles and separation from my wife (logistic, not personal - she's with her very ill mother). I don't think I can be around my friends without drinking - all our socialising revolves around pubs and bars.

I had routine bloods which showed an ALT of 57 (upper normal 40), no AST performed - it was normal 18 months ago. This was after a few weeks of heavier drinking than normal. I'm devastated and am not sure I can stop completely, but will really try to cut-down.

My questions are:

1) Could this elevation have been caused by the few-week binge before the test instead of more generally and thus could it be a transient release of enzymes that will stop with reduction in intake, or does it definitely mean ALD?
2) Should I get an AST done to see if it is more permanent damage (I've read the ratio increase is largely with advanced disease), or ask for a liver USS or fibroscan?
3) If I reduce significantly when should I get tested again - I've read six months but that seems like an age away. Could I get it done in 1 month?
4) If it is still elevated then and I manage to stop - will I ever be able to drink again if I manage a much more moderate lifestyle (glass of wine with dinner, few drinks with friends)?

Best wishes,


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