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Choledocholithiasis Pain Tied to Increasing Transaminases

Aspartate aminotransferase and alanine aminotransferase in particular rise over time

THURSDAY, Dec. 23 (HealthDay News) -- In patients with acute symptomatic choledocholithiasis, increasing duration of pain is associated with increasing liver function tests (LFTs), especially transaminases, according to research published in the December issue of Clinical Gastroenterology and Hepatology.

Ala I. Sharara, M.D., of the American University of Beirut Medical Center in Lebanon, and colleagues conducted a retrospective study of 40 patients, identified by a hospital endoscopy database from 2004 to 2008, with proven choledocholithiasis, who presented within 12 hours of acute pain onset.

The researchers found that aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly correlated with duration of pain, and there was a weaker correlation between duration of pain and γ-glutamyl transpeptidase. The correlation was insignificant for alkaline phosphatase and bilirubin. This temporal association was stronger in patients who had undergone cholecystectomy versus those with intact gallbladders. Of the 18 patients who had normal or almost normal LFTs within the first six hours of pain, the results of transabdominal ultrasound were abnormal in six patients. Repeat LFTs within 24 hours showed large increases in ALT and AST levels (mean 10.5- and 6.8-fold, respectively), intermediate increases in γ-glutamyl transpeptidase levels, and no change in alkaline phosphatase levels. This significant increase in LFTs was the only indication of biliary pathology prior to endoscopy in 11 of the 18 patients.

"Patients with normal LFTs and ultrasound upon presentation should have repeat LFTs if biliary pain is suspected," the authors write.

Abstract
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