From the Guidelines
Elevated liver enzymes indicate potential liver damage or inflammation, and the most appropriate course of action is to consult with a healthcare provider for proper evaluation and treatment, as recommended by the most recent study 1. Elevated liver enzymes can be caused by a variety of factors, including medications, alcohol consumption, viral hepatitis, fatty liver disease, and autoimmune conditions.
- Common causes of elevated liver enzymes include:
- Medications (like statins, antibiotics, or pain relievers)
- Alcohol consumption
- Viral hepatitis
- Fatty liver disease
- Autoimmune conditions
- The liver has remarkable regenerative capacity, and addressing the underlying cause often allows enzyme levels to normalize over time, as noted in the study 1.
- Treatment depends on the underlying cause, and may include:
- Lifestyle changes for fatty liver disease (weight loss, healthy diet, regular exercise)
- Antiviral medications for viral hepatitis
- Medication adjustments if drug-induced
- Regular monitoring through blood tests will help track progress and ensure the effectiveness of treatment, as recommended by the study 1.
- It is essential to consider other potential causes of liver disease, such as nonalcoholic fatty liver disease, genetic/metabolic liver disease, autoimmune hepatitis, and Wilson’s disease, as mentioned in the study 1.
- The extent of evaluation for other causes of liver disease varies from patient to patient, and children with HBV DNA levels below 2000 IU/mL generally require the most extensive evaluation, as noted in the study 1.
From the FDA Drug Label
Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogue inhibitors, including entecavir, alone or in combination with antiretrovirals. Increased transaminases.
Elevated liver enzymes can occur with entecavir use, as evidenced by reports of lactic acidosis and increased transaminases 2, 2, and 2.
- Lactic acidosis has been reported, often in association with hepatic decompensation, other serious medical conditions, or drug exposures.
- Increased transaminases have been reported during postmarketing use of entecavir. It is essential to monitor hepatic function closely with both clinical and laboratory follow-up for at least several months in patients who discontinue anti-hepatitis B therapy, including entecavir.
From the Research
Causes of Elevated Liver Enzymes
- Elevated liver enzymes can be caused by various factors, including excessive alcohol use, non-alcoholic fatty liver disease, and viral hepatitis 3.
- Viral hepatitis, such as hepatitis B, C, and E, can lead to liver damage and elevated liver enzymes 4, 5.
- Other causes of elevated liver enzymes include medication-induced liver injury, autoimmune hepatitis, and hemochromatosis 6.
Patterns of Liver Enzyme Elevation
- Abnormal liver biochemical tests can be categorized into a hepatocellular pattern or cholestatic pattern based on the magnitude of aminotransferase elevation 6.
- Hepatocellular pattern causes include non-alcoholic fatty liver disease, alcohol use, and chronic viral hepatitis 6.
- Cholestatic pattern causes include biliary pathology and other conditions with hyperbilirubinemia 6.
Importance of Accurate Interpretation
- Accurate interpretation of liver biochemical tests is crucial for appropriate further workup, treatment, and referral 6.
- Prompt treatment can improve the natural history of several liver diseases and reduce the risk of progression to liver cirrhosis 6.
- Disregarding pathological liver enzymes may lead to a delay in the treatment of a liver disease 3.