From the Guidelines
Elevated alkaline phosphatase (ALPO4) and gamma-glutamyl transferase (GGT) together suggest liver dysfunction, particularly involving the biliary system, and the most important next step is to consult with a healthcare provider for proper evaluation, which should include a comprehensive liver panel, abdominal ultrasound, and possibly additional imaging studies, as recommended by the most recent guidelines 1. The combination of elevated ALPO4 and GGT points more toward biliary issues than general liver cell damage, which would typically show different patterns of enzyme elevation. Common causes of these elevations include biliary obstruction, cholestasis, alcohol use, certain medications, fatty liver disease, and viral hepatitis. Key considerations in the evaluation of elevated ALPO4 and GGT include:
- Reviewing the patient's clinical history and medications to identify potential causes of liver dysfunction
- Performing imaging studies, such as abdominal ultrasound or magnetic resonance cholangiopancreaticography (MRCP), to evaluate the biliary tree and detect any obstructions or abnormalities
- Considering the diagnosis of primary sclerosing cholangitis (PSC) in patients with inflammatory bowel disease (IBD) and abnormal liver biochemistry test findings, as recommended by the European Society of Gastrointestinal Endoscopy (ESGE) and the European Association for the Study of the Liver (EASL) 1 While waiting for medical evaluation, it is recommended to:
- Avoid alcohol consumption
- Review current medications with your doctor
- Maintain a healthy diet low in processed foods and saturated fats No specific medication is recommended without proper diagnosis. The diagnosis and management of elevated ALPO4 and GGT should be guided by the most recent and highest quality evidence, including the guidelines from the American College of Radiology 1 and the European Association for the Study of the Liver (EASL) 1.
From the Research
Raised ALP and GGT
- Elevated serum levels of alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) can indicate hepatobiliary disease 2.
- ALP and GGT are not liver-specific, and GGT activity can be induced by alcohol and certain drugs 2.
- A hepatic enzyme pattern (predominant transaminase elevation) should be discriminated from a cholestatic pattern (predominant AP and GGT elevation) 2.
Cholestatic Liver Disease
- Ursodeoxycholic acid (UDCA) is used to treat cholestatic liver diseases, with mechanisms of action including protection of cholangiocytes, stimulation of hepatobiliary secretion, and protection of hepatocytes against bile acid-induced apoptosis 3, 4.
- UDCA has been shown to improve serum liver chemistries and may delay disease progression in primary biliary cirrhosis and primary sclerosing cholangitis 3.
GGT and ALP Elevations
- GGT activity has limited utility in assessing ALP elevations, with low sensitivity and specificity for predicting hepatic or nonhepatic ALP isoform elevation 5.
- In patients with enlarged polycystic liver, UDCA treatment has been shown to reduce GGT and ALP levels, although the effect on liver volume is unclear 6.