National Institute on Alcohol Abuse and Alcoholism. This content is owned by the AAFP. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. Caporaso N, 2006;354(1):54–66. Autoimmune hepatitis (AIH) should be considered a possibility in any individual with acute or chronic hepatitis, particularly in those with high immunoglobulin G (IgG) levels. The diagnostic accuracy of US, CT, MRI and 1H-MRS for the evalutation of hepatic steatosis compared with liver biopsy: a meta-analysis. Want to use this article elsewhere? Vasudevan G, Information from references 3 through 5, and 30. Roberts EA, 2010;376(9756):1916–1922. Am J Cardiol. Stefan N, Gorham JD, Drug-related hepatotoxicity. If test results are normal, a trial of lifestyle modification with observation or further testing for less common causes is appropriate. Bohte AE, JAMA. Heard KJ, 2002;346 (16):1221–1231. No. Measurement of liver enzymes is common in primary care, and has likely increased the prevalence of asymptomatic patients with mild elevations in alanine transaminase (ALT) and aspartate transaminase (AST) levels. American Gastroenterological Association medical position statement: evaluation of liver chemistry tests. Several extrahepatic causes of asymptomatic elevations of liver transaminase levels can be pursued based on the clinical scenario. Diagnosis and management of autoimmune hepatitis. Gossios TD, Hepatology. Pharmacotherapy. Consensus recommendations for managing asymptomatic persistent non-virus non-alcohol related elevation of aminotransferase levels: suggestions for diagnostic procedures and monitoring. Retrieved February 10, 2021, https://arupconsult.com/content/autoimmune-hepatitis. et al. Other common causes include alcoholic liver disease, medication-associated liver injury, viral hepatitis (hepatitis B and C), and hemochromatosis. American Association for Study of Liver Diseases. 27 PH 355 January 1995. http://pubs.niaaa.nih.gov/publications/aa27.htm. Watkins PB, Schwenzer NF, Clark JM. GREACE Study Collaborative Group. The course may range from subclinical and very mild to … The most common cause is nonalcoholic fatty liver disease, which can affect up to 30 percent of the population. Diagnosis and management of autoimmune hepatitis. 13. 22. Sandhaus RA. It is not clear how thyroid disorders elevate liver transaminase levels, but measurement of serum thyroid-stimulating hormone can help rule out this potential cause. Pravastatin in Chronic Liver Disease Study Investigators. Czaja AJ, Relapse Relapse occurs in 50% of patients within 6 months of treatment withdrawal and in 80% of patients within 3 years of treatm… Diehl AM. Alcohol Alert. Morisco F, van Werven JR, Manns MP, Angulo P. 2009;13(2):167–177. Dosages of 4 g per day for five to 10 days have been shown to cause elevations in up to 58 percent of healthy nondrinkers.14,15 Alcohol consumption may potentiate the hepatotoxic effects, even with lower dosages of acetaminophen.16, Statins. Ben-Menachem T, Am J Gastroenterol. Additional testing may include ultrasonography; measurement of α1-antitrypsin and ceruloplasmin; serum protein electrophoresis; and antinuclear antibody, smooth muscle antibody, and liver/kidney microsomal antibody type 1 testing. Print, Management of mild liver transaminase abnormalities. Lee SP. Celiac disease has also been implicated in asymptomatic liver transaminase elevations; tissue transglutaminase antibody testing can have a role in this diagnosis.5 Hemolysis and strenuous exercise also may be potential causes. Treatment is indicated in patients with severe disease (aminotransferase levels greater than 10-fold the upper limit of normal; or 5-fold the upper limit of normal with a serum gamma-globulin level at least twice the upper limit of normal; or bridging necrosis or multiacinar necrosis on liver histology). Accessed October 7, 2010. Autoimmune hepatitis. Statin safety: a systematic review. Dig Liver Dis. 2. Author disclosure: No relevant financial affiliations to disclose. The National Health and Nutrition Examination Survey found elevated liver transaminase levels in up to 8.9 percent of the survey population.1,2 Although there are several published guidelines for the workup of asymptomatic transaminase level elevations,3–5 evidence from large prospective studies is sparse. Aj, Gorham JD, et al slow the progression of the liver ; AST = aspartate transaminase..... 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