Normal Liver Enzymes Should Not Exclude Biopsy

Study reports 59 percent rate of non-alcoholic steatohepatitis in patients with normal alanine aminotransferase levels

FRIDAY, Sept. 12 (HealthDay News) -- Because more than 50 percent of non-alcoholic fatty liver disease patients with normal alanine aminotransferase (ALT) levels may have a potentially progressive liver disease, normal ALT should not be a contraindication for biopsy. Histological assessment may be especially warranted in patients with diabetes or insulin resistance who have normal ALT levels, according to research published in the September issue of Hepatology.

Anna Ludovica Fracanzani, M.D., of the University of Milan in Italy, and colleagues reviewed the histological data of 458 patients, including 395 who underwent biopsy because of altered liver enzymes and 63 who underwent biopsy because of persistently elevated ferritin or severe steatosis.

The researchers diagnosed non-alcoholic steatohepatitis in 59 percent of patients with normal ALT levels and in 74 percent of those with elevated levels. In patients with normal ALT levels, they also found that diabetes and insulin resistance were the factors most strongly associated with severe liver disease.

"In the absence of biopsy or of an adequate score able to identify subjects at risk, these patients could miss careful follow-up and might be scarcely motivated toward lifestyle modifications that are potentially able to cure their liver disease and the extra-hepatic manifestations of the metabolic syndrome," the authors conclude. "Clinicians should be aware of the importance of a complete clinical evaluation for early diagnosis and treatment of liver disease, as well as the different manifestations of the metabolic syndrome."

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