Can gastroenteritis cause elevated liver enzymes, specifically hepatocellular damage leading to hypertransaminasemia?

From the Guidelines

Gastroenteritis can cause elevated liver enzymes, specifically hepatocellular damage leading to hypertransaminasemia, as evidenced by a pooled prevalence estimate of 15.0% for both aspartate transaminase and alanine transaminase in patients with gastrointestinal symptoms 1. When considering the relationship between gastroenteritis and liver enzyme elevation, it's crucial to recognize that while gastroenteritis primarily affects the digestive tract, certain infections or severe complications can lead to liver involvement. The study by 1 highlights the gastrointestinal and liver manifestations of COVID-19, including a significant prevalence of elevated liver enzymes, which suggests that gastrointestinal infections can indeed have an impact on liver function. Key points to consider include:

• The prevalence of elevated liver enzymes in patients with gastrointestinal symptoms, as reported in the study 1, indicates a potential link between gastroenteritis and liver damage.
• The study's findings are based on a meta-analysis of 47 studies, including 10,890 unique patients, which provides a robust dataset for understanding the relationship between gastrointestinal infections and liver enzyme elevation 1.
• It's essential to differentiate between the direct effects of gastroenteritis on the liver and other potential causes of elevated liver enzymes, such as viral hepatitis, medication effects, or underlying liver disease.
• Severe dehydration from gastroenteritis can also lead to temporary liver function abnormalities, further emphasizing the need for comprehensive evaluation and management of patients with gastrointestinal symptoms and elevated liver enzymes.

From the Research

Gastroenteritis and Elevated Liver Enzymes

• Gastroenteritis can cause elevated liver enzymes, specifically hepatocellular damage leading to hypertransaminasemia, as seen in a case of norovirus gastroenteritis accompanied by marked elevation of transaminases 2.
• The pathogenesis of liver injury concurrent with norovirus gastroenteritis remains unknown, but clinicians should consider liver injury as one of the possible extra-intestinal manifestations of norovirus gastroenteritis 2.

Evaluation of Elevated Liver Enzymes

• Elevated liver enzymes are a common scenario encountered by physicians in clinical practice, and a step-wise algorithm can be used to interpret abnormal elevation of liver enzymes in asymptomatic patients 3.
• The approach to abnormal alteration of liver enzymes should classify enzyme alterations on the basis of pattern (hepatocellular, cholestatic, and isolated hyperbilirubinemia) 3.
• In patients with known, suspected, or unknown nonhepatic diseases, elevated liver enzymes can be caused by various diseases, and sonography or liver histology may be diagnostic 4.

Causes of Elevated Liver Enzymes

• Elevated liver enzymes can be caused by toxins, cardiovascular diseases, obesity, endocrinopathies, infectious diseases, malignancies, collagen disorders, sarcoidosis, and other diseases 4.
• In patients treated with immune checkpoint inhibitors, elevated liver enzymes can occur due to disease progression, other drugs/toxins, other causes, or immunotoxicity 5.
• The type of inflammatory bowel disease can influence the development of elevated liver enzymes, with Crohn's disease having a higher risk of developing new elevated liver enzymes compared to ulcerative colitis 6.