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British Liver Trust
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Reversal of ALT & AST RATIO

Hi there, I have been waiting nearly a year for a Fibroscan in the NHS. I believe I have about another 3-6 month wait. I received blood results last week that my ALT is 38 and my AST is 47. My ratio works out as 1.24. My albumin is 51 and platelets 389. I am now worried sick but after researching things are so contradicting. I have booked for a private Fibroscan in Harley Street, London coating £550. Does anyone know if these results are worrying enough to pay that amount for a private scan or do you know if they’re minimal results m. Be grateful for advice. Thank you

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That’s quite expensive for a fibroscan. I’m sure there may be plenty of other private places you can go for less.

I’m not an expert but your bloods are all within normal range. Albumin is top of the range but nothing that’s stands out.

Was your doctor concerned? What is the reason for you pushing for a fibroscan so urgently?

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When googling AST abd ALT it says that when cirrhosis is present your AST is higher than your ALT

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If you had a concern that you might have cirrhosis would your GP not refer you for an NHS ultrasound scan? Probably wouldn't have too long a wait and ultrasound is sufficient to pick up changes that might indicate cirrhosis.

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I paid for a private ultrasound on 29/11/2017 which showed chronic liver disease and maybe cirrhosis but said an ultrasound isn't void enough to show cirrhosis. The scan results showed "coarse echotexture"

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Two things stand out in your questions, Google and Harley Street.

As Katie says, talk to your GP regarding your concerns and agree a treatment plan, if one is required.

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My GP doesn't want to know

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That is not very good, did they give a reason? I would speak to the practice manager and ask for another GP.

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We see whatever doctor is available. After I paid for the private scan, I took the result to her and she wouldn't refer me, it took 3 months to get referred then when I told her last month I was struggling to stop drinking she just ignored me and didn't say a word to me

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You are registered at the practice? If so, then speak to the practice manager. My suggestion for drinking support would try a Smart Group, there are other ones but this is the NHS model.

smartrecovery.org.uk/

You could also ask the Liver Trust helpline for advice:-

britishlivertrust.org.uk/

Good luck,

Mark.

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£550 for a FibroScan is outrageous. The result is just a number & won't make any difference to your liver health. Your AST is marginally above normal but AST is found in other organs besides the liver whereas ALT is found mainly in the liver. Your ALT is near the top of the normal range. Platelets are in the normal range but ideally it would be better if the number was a little higher. Your figures are a bit like mine (except my AST has never been high). My liver struggles a little—my ALT rises slightly above normal & platelet count drops a little below normal unless I do everything right. While waiting for the FibroScan on the NHS try making lifestyle changes like losing weight gradually if overweight, exercising regularly, follow a healthy diet (not too many carbs or saturated fats) etc. I've done those things as well as avoiding liver stressors like alcohol & painkillers & I can feel the positive difference the changes have made. Waiting a few months for a FibroScan isn't going to make much difference other than saving you £550.

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I completely agree with Edward1952. I just had my fibroscan and was literally in there for 10 mins (if that). My score was 7.5, which my liver consultant mentioned was not too far off normal in his words and explained that it was reversable based on healthy eating and exercise. I am looking to lose 10% of weight in next 3 months.

You could try the same and then have the scan?

It is ultimately your choice and you need to do what ever you need to do, but I would honestly suggest waiting for the NHS.

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Yeah thats a ridiculous amount of money. We can do them privately here for about the equivalent of 50 pounds.

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The ALT/AST (aka De Ritis) ratio inversion, where AST floats over ALT is supposed to be specific to alcoholic liver disease only, and the alarm bells aren't supposed to go off unless you get a 2:1 AST/ALT (AST double ALT) over more than one lab.

There also can also be false positives, as AST is contained in muscle tissue too, and any exertion or exercise can briefly bump AST up and over ALT.

When a De Ritis inversion occurs, sometimes the GGT enzyme can help. GGT is also typically elevated with alcoholic disease, and a substantial and persistently elevated GGT combined with a substantial and persistent De Ritis inversion might be a good reason for an advanced diagnostic like fibroscan.

I wouldn't spend 500 on a private fibroscan based on a 1.24 ratio alone. It's hard waiting for imaging, but you might ask them to call you if they get a cancellation if the place is near by and you can get to it quickly. With luck, you might get seen within a month.

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The 2:1 ratio is suggestive of alcoholic liver disease especially in the presence of an elevated GGT. But not everyone with alcoholic liver disease has that ratio, only about 70 to 80 percent of people do. I certainly have well advanced alcoholic liver disease yet my ratio is 1.3:1. My Alt and Ast are also lower than yours. And my GGT is only one point over normal. So it's not a Yay or Nay without other testing to go on with it. Again a doctor wont usually even care if it is a 2:1 if it's in normal range and you dont have an elevated GGT. Keep in mind mild elevations of aminotransferase are typically considered 2 to 3 times the upper limit of normal. That being said it would certainly be of interest to me if I was a doctor as to why your labs are sitting in the upper range of normal. Especially if its constant.

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You could have a look at this, more cost effective than Harley Street:-

britishlivertrust.org.uk/ou...

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Thank you everyone. I feel much better now. I was so worried and have cancelled my appointment at Harley Street. I may go to the Liver Trust Thing in Convent Garden on 26 March. I was getting myself in such a state. On the up side I’m 12 dats sober and eating more healthy. Thank you x

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