From the Guidelines
Elevated Gamma-Glutamyl Transferase (GGT) is managed by addressing the underlying cause, with a primary approach involving lifestyle modifications and potentially discontinuing hepatotoxic medications, as indicated by the most recent study 1. The management of elevated GGT focuses on identifying and treating the underlying condition, rather than solely focusing on reducing the enzyme level.
- Lifestyle modifications are crucial, including reducing or eliminating alcohol consumption, as alcohol is a common cause of GGT elevation.
- Weight loss of 5-10% of body weight is recommended for patients with fatty liver disease, achieved through a balanced diet and regular exercise (150 minutes of moderate activity weekly) 1.
- Patients should discontinue hepatotoxic medications when possible and control underlying conditions like diabetes with appropriate glycemic targets (HbA1c <7%).
- For alcohol-related elevations, complete abstinence is necessary, potentially with support from medications like acamprosate or naltrexone for those with alcohol dependence.
- In cases of viral hepatitis, specific antiviral treatments are indicated, and for autoimmune hepatitis, prednisone combined with azathioprine is typically prescribed.
- Regular monitoring of GGT levels every 3-6 months is important to assess treatment effectiveness, with normalization of levels indicating successful management of the underlying condition, as suggested by the study 1. It is essential to note that the choice of imaging for patients with abnormal liver function tests, including those with elevated GGT, depends on the clinical context, such as hepatocellular or cholestatic predominance, and the presence of other laboratory abnormalities, as outlined in the study 1.
From the Research
Management of Elevated Gamma-Glutamyl Transferase (GGT)
Elevated Gamma-Glutamyl Transferase (GGT) is associated with various diseases and conditions, including liver disease, cardiovascular disease, diabetes, and metabolic syndrome 2, 3, 4. The management of elevated GGT involves addressing the underlying cause of the elevation.
- Lifestyle Modifications: Lifestyle changes such as reducing alcohol consumption, losing weight, and increasing physical activity can help lower GGT levels 3.
- Medical Treatment: Medical treatment for elevated GGT depends on the underlying cause. For example, if the elevation is due to liver disease, treatment may involve medications to reduce liver inflammation and scarring 5.
- Monitoring: Regular monitoring of GGT levels and other liver enzymes can help track the progression of liver disease and the effectiveness of treatment 3, 5.
Associated Conditions
Elevated GGT is associated with various conditions, including:
- Liver Disease: GGT is a well-established serum marker for alcohol-related liver disease and other liver conditions 2, 3, 5.
- Cardiovascular Disease: Elevated GGT is linked to increased risk of cardiovascular disease, including cardiovascular mortality, atrial fibrillation, and congestive heart failure 2, 4.
- Diabetes: Elevated GGT is associated with an increased risk of diabetes and metabolic syndrome 2, 6, 4.
- Metabolic Syndrome: GGT is often elevated in patients with metabolic syndrome and non-alcoholic fatty liver disease (NAFLD) 4.
Biomarker for Disease Risk
GGT is a predictive biomarker for disease risk, including:
- Oxidative Stress: GGT plays a role in antioxidant defense mechanisms and can be a surrogate biomarker of oxidative stress 3, 5.
- Mortality Risk: Elevated GGT is associated with an increased risk of mortality across a range of non-hepatic disease pathologies, including metabolic and cardiovascular risk, chronic kidney disease, and neoplasia 2, 5.