Until a couple of years ago, management of moderately raised ALT seemed
straight forward: ask for a liver US and if it showed fatty changes and the
patient had risk factors for this (e.g. diabetes, obesity, alcohol) then
take it no further action apart from recommending lifestyle changes. If
there wasn't a fatty liver then do all the virology, coppers etc and
consider liver biopsy.
Unfortunately NASH (nonalcoholic steatohepatitis) has come along as a group
of fatty liver patients who have a bleak outlook and who may have very
modestly raised ALTs on presentation. Some colleagues have suggested it is
an American disease aimed at ensuring good incomes for gastroenterologists
through doing many more liver biopsy procedures, but at the very least it
means we cannot dismiss fatty change as a completely benign condition.
See N Engl J Med 2002; 346:1221-1231, Apr 18, 2002. for a review.
Eric
----- Original Message -----
From: Julian Barth <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, May 02, 2002 10:52 AM
Subject: Re: ALT reference ranges
> snip
> > Which raises the point of whether we should quote reference ranges or
> > action limits. It seems obvious that some of the rise in ALT is due
to...
>
> The is an excellent review of LFTs (NEJM 2000;342:1266-71) which
> puts the issue of ALT into perspective.
>
> " A minor elevation (less than twice the normal value) may be of no
> clinical importance ...*... and, in fact, may not even be abnormal."
>
> (* if the disorders in table 1 have been excluded)
>
> Our experience is that numbers of patinets with diabetes and
> uncomplicated obesity have fatty liver which results in elevated
> aminotransferases. Perhaps we should have disease and weight
> related ranges (in addition to age and sex) !!
>
> Julian
>
> ___________________________________________________
>
> Julian H Barth
> Department of Clinical Biochemistry & Immunology
> Leeds Teaching Hospitals NHS Trust
> Leeds General Infirmary
> Leeds LS1 3EX
> tel 0113-392-3416
> fax 0113-392-5174
> ___________________________________________________
>
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