What is the interpretation of mildly elevated Gamma-glutamyltransferase (GT) in a 55-year-old female with a history of intermittent diarrhea?

From the Guidelines

A gamma-glutamyl transferase (GGT) level of 44 in a 55-year-old female with intermittent diarrhea represents a mild elevation that warrants further investigation but is not severely abnormal. This slight elevation could be related to several factors including mild liver dysfunction, medication effects, alcohol consumption, or biliary tract issues, as suggested by the study published in the Journal of the American College of Radiology 1. Given the concurrent symptom of intermittent diarrhea, I recommend a comprehensive evaluation including complete liver function tests, abdominal ultrasound, and stool studies to identify potential causes of both the diarrhea and elevated GGT. The American Gastroenterological Association (AGA) recommends testing for celiac disease with IgA tissue transglutaminase and a second test to detect celiac disease in the setting of IgA deficiency in patients presenting with chronic diarrhea, as outlined in the study published in Gastroenterology 1.

Key Considerations

• The patient should avoid alcohol completely, review current medications with her physician for potential hepatotoxicity, and maintain adequate hydration.
• If the patient is taking any herbal supplements or over-the-counter medications, these should be temporarily discontinued.
• The connection between diarrhea and mildly elevated GGT could suggest conditions such as irritable bowel syndrome with concurrent fatty liver disease, celiac disease, inflammatory bowel disease, or medication side effects.
• GGT is an enzyme found in liver, bile ducts, and other tissues, and serves as a sensitive but non-specific marker of liver or biliary tract dysfunction, as noted in the study published in the Journal of the American College of Radiology 1.

Potential Causes

• Mild liver dysfunction
• Medication effects
• Alcohol consumption
• Biliary tract issues
• Celiac disease
• Inflammatory bowel disease
• Irritable bowel syndrome with concurrent fatty liver disease
• Medication side effects It is essential to consider these potential causes and conduct a thorough evaluation to determine the underlying cause of the elevated GGT and intermittent diarrhea.

From the Research

Interpretation of Intermittent Diarrhea and Elevated GT

• The patient's symptoms of intermittent diarrhea can be evaluated based on the duration of symptoms, with chronic diarrhea typically defined as lasting more than 4 weeks 2, 3.
• The patient's GT (gamma-glutamyltransferase) level is slightly high at 44, which may indicate liver enzyme elevation 4.
• The combination of intermittent diarrhea and elevated GT may require further evaluation to determine the underlying cause, including history, physical examination, and potentially laboratory tests such as blood and stool tests, endoscopy, or imaging studies 2, 4.
• The patient's symptoms and test results should be considered in the context of potential causes of chronic diarrhea, including irritable bowel syndrome, diet, medications, and other medical conditions 2, 3.

Potential Causes and Evaluation

• The patient's history and physical examination may provide clues to the underlying cause of diarrhea, such as recent travel, foodborne illness, or underlying medical conditions 5.
• Laboratory tests such as stool cultures or molecular studies may be indicated if the patient has bloody or mucoid stools, or if there are risk factors for infectious diarrhea 5.
• The evaluation of elevated liver enzymes should be guided by the clinical presentation and pattern of injury, with consideration of potential causes such as medication adverse effects, alcohol-use disorder, or other liver diseases 4.

Management and Treatment

• The management of intermittent diarrhea and elevated GT will depend on the underlying cause, with potential treatments including antimicrobial therapy, antidiarrheal agents, or supportive care such as oral rehydration 6, 5.
• Empiric antibiotic therapy is rarely warranted, except in cases of sepsis or inflammatory diarrhea, and targeted antibiotic therapy may be appropriate following microbiologic stool assessment 6, 5.