From the Guidelines
Elevated liver enzymes indicate potential liver damage or inflammation, and the most appropriate initial step is to consult with a healthcare provider for proper evaluation and diagnosis of the underlying cause, as recommended by the American College of Radiology in their 2023 guidelines 1.
Causes of Elevated Liver Enzymes
The causes of elevated liver enzymes can be varied, including viral hepatitis, alcohol consumption, fatty liver disease, certain medications, and autoimmune conditions. According to a 2023 study published in the Journal of the American College of Radiology, hepatocellular predominant liver chemistry is seen when aminotransferases are elevated much higher than ALP (cholestatic-pattern) 1.
Diagnosis and Treatment
A complete liver panel, hepatitis screening, and possibly imaging studies like ultrasound or CT scan may be recommended by the doctor. While waiting for the appointment, it is essential to avoid alcohol completely, review medications with the doctor, and maintain a healthy diet low in processed foods and sugar. As noted in a 2023 study, no specific medication can universally lower liver enzymes, as treatment depends on the underlying cause 1.
Imaging Studies
Ultrasound (US) is a useful first-line investigation tool for mild increase in liver enzymes, as it is noninvasive and accurate in detecting steatosis, with a sensitivity of 84.8% and a specificity of 93.6% in moderate and severe hepatic fat deposition 1.
Key Recommendations
- Consult with a healthcare provider for proper evaluation and diagnosis of the underlying cause
- Avoid alcohol completely
- Review medications with the doctor
- Maintain a healthy diet low in processed foods and sugar
- Consider imaging studies like ultrasound or CT scan for diagnosis
- Treatment depends on the underlying cause, and no specific medication can universally lower liver enzymes.
From the FDA Drug Label
Abnormalities in liver enzymes have not been associated with Ursodiol therapy and, in fact, Ursodiol has been shown to decrease liver enzyme levels in liver disease. However, patients given Ursodiol should have SGOT (AST) and SGPT (ALT) measured at the initiation of therapy and thereafter as indicated by the particular clinical circumstances
Crested and elevated liver enzymes are not typically associated with ursodeoxycholic acid (PO) therapy, as the drug has been shown to decrease liver enzyme levels in liver disease 2. However, it is recommended to monitor liver enzymes (SGOT/AST and SGPT/ALT) at the start of therapy and as needed based on clinical circumstances.
From the Research
Elevated Liver Enzymes
Elevated liver enzymes are a common finding in both symptomatic and asymptomatic patients, necessitating further evaluation to clarify the underlying disease 3. The patterns of increased liver enzymes can be defined into three categories:
- A predominant increase in transaminase activities, indicating a disturbance of hepatocellular integrity, which can be found in patients with viral hepatitis, genetic liver diseases, or drug-induced liver diseases 3.
- A pattern characterized by high serum alkaline phosphatase and γ-glutamyltranspeptidase activities, indicating cholestatic liver diseases, which can be further evaluated using ultrasound to discern intra- from extrahepatic cholestasis 3.
- A pattern defined by a predominant rise in γ-glutamyl transpeptidase, which is observed in alcoholic or non-alcoholic fatty liver disease and infiltrating liver diseases 3.
Approach to Elevated Liver Enzymes
The evaluation of elevated liver enzymes should be guided by both the clinical presentation and the pattern of injury 4. Abnormal liver tests are one of the most common challenges in the primary care setting, and primary care practitioners order these tests for numerous reasons, including investigating abdominal signs and symptoms or suspected alcohol-use disorder 4.
Autoimmune Hepatitis
Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease characterized by a mainly T cell-mediated immune response targeting the liver 5. The diagnosis of AIH is based on the elevation of immunoglobulin G/hypergammaglobulinemia, detection of characteristic autoantibodies, and a typical pattern on liver histology 5. Ultrasound findings in AIH have not been reported systematically, but imaging plays an important role in detection of complications and ruling out other possible causes of chronic liver diseases 6. Noninvasive biomarkers for the diagnosis and management of AIH are being researched, including gene expression profiles, proteins, metabolites, and immune cell phenotypes in different stages of AIH 7.