What are the next steps for a patient with elevated Gamma-Glutamyl Transferase (GGT) level of 117?

From the Guidelines

For a patient with an elevated GGT level of 117, the next steps should include a comprehensive evaluation to determine the underlying cause, considering referral to a local specialist for further evaluation if no NAFLD risk factors are present and liver enzymes remain elevated, as suggested by guidelines on the management of abnormal liver blood tests 1. The patient's elevated GGT level may be indicative of liver cell damage or biliary obstruction, and it is essential to investigate further to determine the underlying cause.

• A complete liver function panel (AST, ALT, alkaline phosphatase, bilirubin) should be ordered to assess the extent of liver damage.
• Hepatitis screening and imaging studies such as an ultrasound or CT scan of the liver may also be necessary to rule out other potential causes.
• Lifestyle modifications are crucial, including abstaining from alcohol for at least 2-4 weeks to see if GGT levels decrease, as alcohol is a common cause of elevated GGT, with a relative risk of liver cirrhosis increasing exponentially with alcohol consumption, as noted in the guidelines 1.
• Other important changes include weight loss if overweight, adopting a low-fat diet, increasing physical activity, and avoiding medications that may stress the liver.
• Regular monitoring of GGT levels every 3-6 months is advisable to track changes and response to interventions. It is also important to consider the patient's medical history, including the presence of NAFLD risk factors such as type 2 diabetes mellitus, BMI >25, dyslipidaemia, and hypertension, as these factors can increase the risk of liver disease, and synergy between alcohol intake and obesity can double the risk of liver disease when BMI is >35, as highlighted in the guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Elevated GGT Level of 117: Next Steps

• A patient with an elevated Gamma-Glutamyl Transferase (GGT) level of 117 should undergo further evaluation to determine the underlying cause of the elevation 2, 3, 4, 5, 6.
• The patient's medical history, physical examination, and laboratory results should be reviewed to identify potential risk factors for liver disease, such as alcohol consumption, obesity, and metabolic syndrome 2, 4, 6.
• Additional laboratory tests, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), may be ordered to assess liver function and rule out other causes of elevated GGT 3, 4, 5.
• Imaging studies, such as ultrasound or computed tomography (CT) scans, may be performed to evaluate the liver and bile ducts for signs of disease or obstruction 2, 3.
• The patient's anthropometric indices, such as body mass index (BMI) and visceral fat area (VFA), should be assessed to identify potential associations with elevated GGT levels 4.
• The patient's cardiovascular risk factors, such as hypertension, diabetes, and hyperlipidemia, should be evaluated, as elevated GGT levels have been associated with an increased risk of cardiovascular disease 5, 6.

Potential Underlying Causes

• Nonalcoholic fatty liver disease (NAFLD) 2, 4, 6
• Alcoholic liver disease 5
• Obstructive liver disease 3, 5
• Metabolic syndrome 4, 6
• Cardiovascular disease 5, 6

Importance of Further Evaluation

• Elevated GGT levels have been associated with an increased risk of liver disease, cardiovascular disease, and mortality 2, 5, 6.
• Early identification and management of underlying causes can help prevent progression of disease and improve patient outcomes 2, 4, 6.