High liver function tests

[Purpletop]

I have had high liver function test results for the past year and a half, fluctuating between twice and five times the upper normal limit. Initially it was the GGT that was high. Then the ALT, then the ASP and now the AST as well. Plus my urea is v low. I have done all the possible imaging tests and had a liver biopsy too. The biopsy showed slightly fatty liver but the hepatologist does not believe that it is the cause of such high levels. All the imaging tests show smooth, normal liver, no gall stones. The gallbladder is slightly "lazy" but the tests did not conclusively show that it isn't functioning. I have no outward signs of liver disease.

The hepatologist believes that it is a sphincter of Oddi disorder (making the bile backing up in the liver, thereby increasing the function levels). To get a clear diagnosis for that I need to have a specific endoscopic procedure to measure the pressure of that sphincter but as I have not much pain, nor visible signs, and taking into account that the procedure carries the risk of pancreatitis, I'm reluctant to have it.

I'm also a lupus sufferer but the biopsy etc confirmed that it isn't the one affecting the liver. The antibodies related to liver are negative. PBC has been ruled out, hepatitis has been rippled out (including the autoimmune).

Still, I'm worried about these high results. I have been on a very strict diet for the past 6 months to control the lupus, no alcohol either. I expected the results to improve but they haven't. My hepatologist says that that is the nature of disorders of the sphincter of Oddi but I'm worried that it is liver disease that is not being picked up.

Has anyone had such high results (up to 5 times over the normal upper limit) without having any visible signs of liver disease? If so, what was your diagnosis?

Many thanks.

[Bolly]

Did you see the written liver biopsy report and if so, was there anything in there that mentioned the high liver enzymes - I notice you dont mention bilirubin or albumin which are also measured when you have a liver function test done, so assume these are normal?

If the biopsy you mention was a liver biospy then its unlikely that liver disease has been missed, assuming a decent pathologist did the report.

There is a blog here lupusadventurebetweenthelin... by a lupus patient who had high liver enzymes caused by the lupus.

[Purpletop]

Nothing in the biopsy report mentioned the enzymes and the biopsy was normal. Albumin and globulin are now normal but they have been raised before. I am on Plaquenil which improved my overall liver symptoms but did absolutely nothing to my liver function tests. I take no other lupus drugs that are liver toxic. Even when the inflammation markers CRP/ESR were reduced in the blood tests (an indication of lupus activity quietening down) the liver function tests remained high.

I'm at my wits' end - rheumatologist doesn't believe it is lupus causing it, nor my hepatologist. I've just sent the latest results to the hepatologist and see what he says.

Thank you for responding and for the link to the blog, very useful.

[Bolly]

As the liver biopsy was normal my guess is you can rest assured that your liver isn't damaged in anyway. You could do some research into other lupus patients (is there a support forum out there?) to see if other lupus sufferers like this blogger have elevated LFTs and then take evidence of your research to your rheumatologist.

Something like thelupussite.com/forum/

or forum.wehavelupus.com/forum...

Have your iron levels been checked, sometimes excess iron is stored in the liver and can raise levels.

The trouble with CRP and ESR markers is that although they tell you there is inflammation in the body they dont specify where. You must be feeling poorly with these high levels, what symptoms do you have?

[Purpletop]

I'm actually not feeling that badly, apart from some lupus symptoms here and there. I sometimes have pain in the upper right side of the abdomen but not for long periods and not unbearable. Which is probably why my hepatologist is not that concerned about the liver and has focused on bile ducts etc. Funny you mentioned iron, my ferritin is slightly over the upper limit, so I will raise that, thank you for the tip. I'm on the lupus uk forum on healthunlocked, I will raise this question, good thinking.

Many thanks for your help!