From the Guidelines
Management of significantly elevated GGT levels indicating severe liver dysfunction requires a comprehensive approach, prioritizing lifestyle changes, including diet and physical exercise, as the first line of treatment, as supported by recent guidelines 1.
Key Considerations
- Identify and address the underlying cause of liver dysfunction, which may include alcohol cessation, medication review to discontinue hepatotoxic drugs, and treatment of viral hepatitis if present.
- Supportive care is essential, including adequate hydration, nutritional support with a low-protein diet in cases of encephalopathy, and vitamin supplementation (particularly B vitamins).
- Medications may include ursodeoxycholic acid to improve bile flow, lactulose for hepatic encephalopathy, and diuretics like spironolactone and furosemide for ascites management.
- Regular monitoring of liver function tests, coagulation parameters, and renal function is crucial.
- Patients should avoid alcohol completely and take only essential medications at the lowest effective doses.
Imaging Recommendations
- For patients with abnormal liver function tests with hepatocellular predominance, US abdomen and US duplex Doppler abdomen are usually appropriate as the initial imaging 1.
- For patients with cholestatic predominance and elevated ALP with or without elevated gamma-glutamyl transpeptidase, US abdomen, MRI abdomen without and with IV contrast, and CT abdomen and pelvis with IV contrast are usually appropriate as the initial imaging 1.
Referral to Specialist
- For severe, progressive liver dysfunction, referral to a hepatologist is necessary to evaluate for potential liver transplantation.
- A recent study suggests that lifestyle changes, including weight loss and physical exercise, are essential in managing NAFLD, and drugs like metformin, ursodesoxycholic acid, and vitamin E may be considered in certain cases 1.
From the Research
Causes of Elevated GGT Levels
- Elevated Gamma-Glutamyl Transferase (GGT) levels can be caused by various liver diseases, including primary biliary cholangitis (PBC), drug-induced liver injury (DILI), alcoholic liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD) 2
- The highest level of GGT was up to 1000.00 to 2000.00 U/L in PBC and DILI, and the highest level of GGT was more than 2000.00 U/L in ALD 2
- GGT levels are also associated with oxidative stress and cholestasis in different liver diseases 2, 3
Management of Elevated GGT Levels
- The management of a patient with significantly elevated GGT levels indicating severe liver dysfunction depends on the underlying cause of the elevation 2, 4
- In cases of ALD, the management may involve addressing oxidative stress and cholestasis, while in cases of NAFLD, the management may involve addressing oxidative stress and fatty liver changes 2, 5
- Elevated GGT levels are also associated with an increased risk of mortality, incident type 2 diabetes, cardiovascular events, chronic kidney disease, and cancer, independent of alcohol consumption and other prognostic factors 4
Diagnostic Value of GGT
- GGT is a marker of oxidative stress and cholestasis, but its low specificity means that clinicians often ignore its diagnostic value 2
- However, GGT levels can be useful in establishing the particular stage of alcoholic liver disease by a simple enzyme test in the serum 6
- The determination of various forms of GGT in the serum of alcoholics may be useful in diagnosing the stage of alcoholic liver disease 6