From the Guidelines
Transaminitis should be managed by identifying and treating the underlying cause, with initial evaluation including a complete medical history, physical examination, and liver function tests, and treatment focusing on the underlying cause, such as antiviral medications, weight loss, or immunosuppressants. The management of transaminitis depends on the severity of the elevation and the presence of symptoms.
- For mild elevations (less than 5 times the upper limit of normal) and asymptomatic patients, monitoring liver enzymes every 2-4 weeks while avoiding hepatotoxic substances like alcohol and acetaminophen is appropriate 1.
- For moderate to severe elevations, additional testing such as viral hepatitis panels, autoimmune markers, ultrasound imaging, and possibly liver biopsy may be necessary 1. Some common causes of transaminitis include:
- Nonalcoholic fatty liver disease (NAFLD) and alcohol-induced liver disease, which are the most common causes of fatty liver disease 1
- Viral hepatitis, autoimmune hepatitis, and hereditary hemochromatosis, which can cause hepatocellular injury and release of liver enzymes into the bloodstream 1
- Medications and toxins, which can cause liver damage and elevate liver enzymes 1 It is essential to discontinue potentially hepatotoxic medications and avoid substances that can exacerbate liver damage, such as alcohol and acetaminophen 1. Liver enzymes typically normalize within weeks to months with appropriate treatment, though chronic conditions may require ongoing management 1.
From the Research
Definition and Prevalence of Transaminitis
- Transaminitis refers to the elevation of liver transaminase levels, which can be asymptomatic or symptomatic 2.
- It is estimated that approximately 10% of the U.S. population has elevated transaminase levels 2.
Causes of Transaminitis
- The most common causes of elevated transaminase levels are nonalcoholic fatty liver disease and alcoholic liver disease 2.
- Uncommon causes include drug-induced liver injury, hepatitis B and C, and hereditary hemochromatosis 2.
- Rare causes include alpha1-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease 2.
- Extrahepatic sources, such as thyroid disorders, celiac sprue, hemolysis, and muscle disorders, are also associated with mildly elevated transaminase levels 2.
- Inflammatory bowel disease (IBD) can also cause abnormal liver biochemical tests, including transaminitis 3.
- Certain medications, such as oxaprozin 4, statins 5, and antituberculous therapy 6, can induce transaminitis.
Evaluation and Management of Transaminitis
- The initial evaluation of transaminitis should include an assessment for metabolic syndrome and insulin resistance, a complete blood count with platelets, measurement of serum albumin, iron, total iron-binding capacity, and ferritin, and hepatitis C antibody and hepatitis B surface antigen testing 2.
- If testing for common causes is consistent with nonalcoholic fatty liver disease and is otherwise unremarkable, a trial of lifestyle modification is appropriate 2.
- If the elevation persists, hepatic ultrasonography and further testing for uncommon causes should be considered 2.
- In cases of drug-induced transaminitis, discontinuation of the offending medication is often necessary [(4,5,6)].
- Liver transplantation may be necessary in severe cases of transaminitis, such as fulminant hepatic failure 6.