Elevated ALT at 65 u/l

[Gemma01]

Hi all hope you are well. I seen my gastro last week and have just had my results back. 6 months ago he said that my ATL was showing mild abnormalities. He tested me again and it is now 65 a/l. He said when I was last tested he was slightly concerner about PBC and AIH overlap because of my elevated ALT's but as i'm showing no symtoms of fatigue that it has reasurred him and he will just monitor it. I'm really confused and don't no what this means. I've come to terms with PBC but having an overlap of AIH to go with it really scares me and I don't no what to do in regards to these results.

[GrittyReads]

I take it from what you say that you have already been officially diagnosed with PBC, and that it is the possibility of overlap AIH you are worried about. I'm afraid I know little about AIH, but presumably you test +ve for AMAs, and/or have had abnormal lfts, and/or have had a liver biopsy that confirms bile duct damage - ideally you need two of these for PBC to be confirmed. If PBC was confirmed are you on Urso? I would talk to the Liver Trust (also a site on here) and the PBC Foundation .. and read the PBC F booklet about diagnosis of PBC and the readings for the liver function test levels: it will help you feel more confident when talking to and questioning your gastro.

I hope others email in to you with better info on PBC AIH overlap than I can give, but a bit more about your exact diagnosis and history might help them to advise you more. Take care.

[Mumoftwo81]

Hi, I was diagnosed with PBC last month and started on URSO as my ALP had risen to 135. Currently not symptomatic. I Had a positive AMA since tests in August 2012, but liver functions were normal then. And Alp continued to be normal until jan 2014. I also have elevated ALT, currently 61. It has been persistently elevated in the last year but always around 60-65. I was told by my specialist that currently he believes I have pure PBC but was slightly concerned that my ALT was elevated even though not dramatically so.

He said that if the URSO worked for me then the raise in ALT may be due to inflammation caused by the PBC and should therefore normalise over time and not due to AIH overlap. I get more bloods in a week so ? The significance of the level change in 2 months, but we will see. He wrote the comparisons of pure PBC and overlap down for me:

Pure PBC: raised ALP, normal/static ALT, raised OR normal IgG, raised Igm, raised or normal bilirubin

PBC/AIH overlap: ANA -ve, raised ALP, usually v high ALT, raised IgG, static Igm, normal or raised bilirubin.

I take it from this that if your IgG is normal then it isn't overlap, I am not sure what my results for IgG we're for last time?

I need to check on these next set of bloods to see how they compare to the above. I was told that if my ALT continued to rise or indeed didn't reduce then they may consider a liver biopsy to determine if it is overlap and also to stage my PBC. I too am only relatively young, age 32, and this has been a shock to the system, esp as I have no other health issues and 2 hound children. Good luck Gemma in finding your answers and apologies for the essay!!

[Mumoftwo81]

Also meant to ask are you currently on URSO or has your ALP been in normal range?

[EAJSWW]

I have pbc diagnosed 13 yrs ago. I have AIH who h was diagnosed on biopsy 9 yrs ago. My alkphos never stabilized on urso which was stopped because i was told I was a none responder. Funnily enough after stopping the urso my itching also stopped. My alt has never been below about 130 and I take steroids and immunosuppression to help with the AIH . my bloods get a bit better then they go crazy again for a few months. All you can do is ensure you are getting the right treatment for pbc . check with foundation. And make sure you are getting best treatment for your aih . check with liver foundation.

Not everyone sufferers from fatigue and it isn't stage dependant. You cN be early disease and have severe fatigue and fairly advanced disease and have little fatigue.

[Gemma01 in reply to EAJSWW]

Hi i've not been told I have AIH, i'm not on urso, i have just PBC but he was worried i have an overlap as my alt is 65 but as I'm not fatigue he thinks i've not got aih. Why else would my alt thats what concerns me.

[Mumoftwo81]

Like I say my ALT is also a bit raised, it should be less than 40 and it's around 61 now. Has your specialist said when to next have your bloods tested? Also are you having your bloods tested at your gastro apt?

I was at first and would get a note through the post with my results. This isn't overly helpful as once you have the results you have to then wait until next apt to discuss it. Is it possible to get your bloods checked at GPS the week before your gastro apt and get a print out to take to your gastro apt? That's what I'm doing next week as I too am having ALT monitored with the view it could potentially be overlap AIH.

I don't know how high the ALT would need to be before they would think its likely. Like I said previously my specialist suggested liver biopsy to diagnose AIH overlap but it depends what me coming ALTs are like I guess. Good luck.

[Gemma01 in reply to Mumoftwo81]

So has your alt been raised for a while? Do you have any symptoms. I get my bloods done at my gastro appointment then my gastro writes to me and tells me the results and what it means and what will happen next. He has said that as my alt was raised he was concerned of an overlap but lack lf symptoms is reassuring him that I don't have an overlap.

What meds are you on? It worries me if I do have an overlap and I have to take steriods and I pit on weight. Especially as I have high cholestrol.

[Mumoftwo81]

I was poorly 2 years ago with pneumonia a bit after having my son and as can happen when you have a bad infection my kidney function was affected for a very short time, in turn my liver function tests were raised, more so my ALP than anything. It was 190, my ALP came back down over the next 6 months back to normal, but in that time my ALT crept up by 20 every time I had blood tests (3 monthly) it peaked at 84 and back down to 60-65 in the last year.

I started URSO last month, and have had no side affects from it all. Never had any other medical conditions or been on regular medication. Taking them has just become the norm now. I'm not sure about the relevance of not being fatigued linked to not having AIH overlap? I've not really looked into AIH overlaps yet. I don't think I will unless I am told that i have it. Cos it's just another thing to get bogged down with. You might have already said this but is your ALP normal? My specialist was basically waiting for my ALP to be raised before starting URSO but it is supposed to slow the progression. I know what you mean about the steroids, I too would rather not need steroids but I guess we just have to go with the flow.

[Gemma01 in reply to Mumoftwo81]

Thank you so much for your reply your so positive and Its true that unless i'm told I have the overlap, if I have it then I should just put it to the back of my mind. I have not been given urso. I've just asked for a print out of all of my bloods which my gastro will send to my doctor so I will tell you what my alp is then. So do you jjst feel tired then. I think I can cope with pbc just so frightend that I will get the overlap and have to take steriod and put on weight.

[Mumoftwo81]

Trust me I wasn't a month ago! Basically my thought is yes ihave Pbc which we think is in v early stages and as I have no symptoms whatsoever, no I'm not tired, well I so work on a busy ITU and have 2 young children so just normal levels of tiredness due to that. I figure apart from regular

testing and taking URSO it's not affecting My life so why let it! If I do develop symptoms in time what's the point In wasting time when I feel fine worrying about what may be or in actual fact might never happen. Keep your chin up.

[Gemma01 in reply to Mumoftwo81]

Thats very true. You really have helped me and have made me see things in a more positive way. Hope to speak to you again soon. Take care x

[Mumoftwo81 in reply to Gemma01]

I'm glad you are feeling a bit more positive. A month ago I wouldn't have believed I would be saying half of these positive things! Cos it just knocks you for six. Have you had the pbc DVD from liver north east? It's very good and also has you read that long document on Pbc foundation website? I found it very useful, take care.