Following on the theme about action limits with Al-T and reinforcing points
made by others, this month's Gut has a leading article on" NASH: where are
we now and where are we going?" It mentions the increasing number of
patients presenting to liver clinics with persistently raised
aminotransferase levels and about deciding when to undertake liver biopsy.
Reviewing several recent publications and with the proviso that they may not
apply to all patients with non-alcoholic fatty liver disease(NAFLD), the
author suggests restricting liver biopsy to patients with some if not all of
the following:
1. ALT more than twice normal
. 2. AST > ALT
3. Moderate central obesity
4. Impaired glucose tolerance or NIDDM
5. Hypertension
6. Raised triglycerides
With the obesity epidemic gaining momentum we can look forward to a further
big rise in the LFT workload and associated tests.
Time to get the bike out.
Roy Fisher
Royal Cornwall Hospital
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