From the Guidelines
If you have high liver enzymes, consult a healthcare provider immediately for proper evaluation and treatment, as high liver enzymes indicate liver inflammation or damage, and the specific treatment depends on identifying the underlying cause. When evaluating high liver enzymes, it is essential to consider the severity of abnormal aminotransferase, which can be classified as mild, moderate, or severe, with moderate and severe being discussed collectively due to significant clinical overlap 1. The treatment approach may involve lifestyle changes, such as avoiding alcohol, maintaining a healthy weight, eating a balanced diet low in processed foods and sugar, and regular exercise. Medications that may help include ursodeoxycholic acid for certain liver conditions, statins if appropriate for the specific situation, and vitamin E in cases of non-alcoholic fatty liver disease 1. Additionally, managing underlying conditions like diabetes or high cholesterol, staying hydrated, limiting acetaminophen use, and getting vaccinated against hepatitis are crucial steps 1. Regular follow-up testing will be necessary to monitor liver function and response to treatment, and a liver biopsy may be considered if the patient is steroid-refractory or if there is concern for other differential diagnoses that would alter medical management 1. It is also important to review medications and supplements that may cause hepatotoxicity and rule out abnormal liver enzymes from development or progression of liver metastases 1. Overall, the goal of treatment is to achieve complete biochemical and histological resolution, although this may not be achievable in some patients, and the aspiration should be the lowest achievable histological and biochemical activity with a minimum of side effects 1.
From the Research
Elevated Liver Enzymes
When liver enzymes are high, it is essential to understand the underlying causes and appropriate management strategies.
- Evaluation should be guided by both the clinical presentation and the pattern of injury, as stated in the study 2.
- The most common causes of abnormal liver testing should be considered, including non-alcoholic fatty liver disease (NAFLD) and alcohol-use disorder.
Management of Elevated Liver Enzymes
Several studies have investigated the management of elevated liver enzymes, including:
- Vitamin E supplementation, which has been shown to reduce liver enzymes and improve liver pathology in patients with NAFLD 3.
- Combination therapy with vitamin E and C, which has been found to be effective in normalizing liver enzymes in patients with fatty liver disease, comparable to ursodeoxycholic acid treatment 4.
- Avoiding acetaminophen (APAP) overdose, as it can cause liver damage, particularly in individuals with hepatic steatosis, obesity, and NAFLD 5.
Alcohol Consumption and Acetaminophen-Induced Liver Injury
Alcohol consumption can also impact liver health, and its relationship with acetaminophen-induced liver injury is complex:
- Chronic alcoholism may potentiate APAP hepatotoxicity, while acute alcohol consumption may have a protective effect against hepatotoxicity 6.
- The timing of alcohol ingestion can affect APAP metabolism and resulting liver injury, highlighting the need for careful consideration of alcohol consumption in patients with elevated liver enzymes.