+ AMA; Slightly elevated ALT

[soulshine02]

Hello, a little history about myself. Last year I had my annual blood test and my ALT was slightly elevated at 45 normal is (0-32); Since it was elevated I demanded testing for hepatitis, hemochromatosis, AIH and PBC. Well my AMA M2 was positive. All other testing was negative. So I had an abdominal US which was normal and have had my AMA and LFT monitored for the past year. My AMA M2 has remained elevated and all LFT where normal range; Just received my lab results today and my ALT was 34 (0-32). I am rather upset because something is going on with my liver and I can no longer pretend everything is fine; I have no symptoms, my weight is within normal range, and I do not take any medications and I quit drinking a year ago. I was curious because I thought ALP was the lab most associated with PBC and mine is normal and never has been elevated. My ALP is 58 (47-117) and it is not even trending up. Has anyone ever had this experience?

[EileenUSA]

Hi

sorry to hear you are not able to get a definitive answer regarding your situation. I do believe there are others on this forum that have tested positive AMA but don't have elevated blood levels. Have you seen a hepatologist? Is their advice to "watch and wait" ?

hopefully others in this situation will chime in but it is the weekend so not as much traffic. Just wanted to send out a virtual hug as I know how stressful NOT knowing what is going on with the body can be.

[soulshine02 in reply to EileenUSA]

Thank you! My next step is going to try to push my primary doctor for a referral.

[SSMPCW123 in reply to soulshine02]

I do not think that you have anything to worry about if everything is normal and the

alt is only 34.

I have AMAs in my blood but

nothing esle points to PBC.

I have bloodwork every 6 months to make sure that

the bloodwork is normal.

Many things can cause the alt

to be a little high.

Just my opinion from what I have been through.

[soulshine02 in reply to SSMPCW123]

Thank you! I will keep that in mind. I have had a lot of anxiety so that probably does not help with my labs.

[periwinkle88]

Hi, I had a similar experience. My ALT was hovering around the top end of the normal range to slightly elevated for a couple months, so my doctor checked me for autoimmune liver diseases (I'd just been diagnosed with Hashimoto's, also autoimmune). My alk phos was at the lower end of the normal range, like yours. My AMA came back positive for PBC, but without an elevated alk phos I needed a biopsy to confirm. I had a biopsy and the report came back with slight inflammation but no sign of PBC. My labs were monitored every three months for a year (they stayed about where they were during that time). Meanwhile, I drove myself crazy worrying, and finally decided to seek a second opinion. SO, about a year after the biopsy I was seen by a hepatologist who sees a lot of PBC patients. He examined the digital biopsy images and found one tiny speck that is hallmark PBC. (This was confirmed with a second opinion by a radiologist.) With no symptoms specific to PBC, and my labs not really too bad, I was diagnosed at stage 0. Seven plus years later, I am still early stage per labs, symptoms, and a recent fibroscan. MY alk phos has gone up to about 72, still very normal. Ursodiol brought my ALT and AST down. The not knowing was the worst part. I hope you can get a firm answer, so you can move on. Good luck!

[soulshine02 in reply to periwinkle88]

Thank you! All the potential medical testing stresses me out. I do need to do my research and find a hepatologist that deals with PBC. I am near Los Angelos so there has to be one around there.

[magst in reply to periwinkle88]

Are you still using Ursodyoxylic acid or was it only a short course?

[periwinkle88 in reply to magst]

I've been on it for a little over three years now.

[claygi]

My ALT and AST were always elevated while my ALP was barley raised (and mostly normal) for 3 years. No raised AMA, then finally it popped up. Then it went super high. Then came back down.

Bottom line, numbers can be all over the place and you might just have PBC brewing. Also, have them check your GGT, that is a hallmark elevation flag for PBC.

[soulshine02 in reply to claygi]

I have an appointment in March so I will mention the GGT lab to my doctor.

[GrittyReads]

Yes, other flags for PBC as well as ALT are mainly ALP, AST and also GGT (which not all medics routinely test for, I've had to insist on it being included in my annual tests, after the leading PBC specialist that I saw said he set great store by its levels.). Usually the levels are pretty high, and I believe minor increases in one or another are not too worrying, although increased monitoring - eg tests every few months rather than annually - is to be advised.

I only have AMAs, it's been known I have them since 1992: but I've never had any other worrying readings, in all that time. However, I always have annual blood tests, ever since AMAs were noted.

Some people just have AMAs - and never show any signs of liver problems. Blood Donor statistics in the UK show that about 8% of the population 'just have' AMAs, and only a max of 2% of that 8% ever go on to develop AMAs. Just having AMAs does not mean you have PBC, or that you will ever get it.

You need AMAs - AND - high levels of the noted liver function tests for an easilyt +ve diagnosis of PBC. If there's any worry, then routine testing but more often. The Gold Standard test is a liver biopsy if AMAS plus LFTS are not enough for a diagnosis, but there is ongoing concern.

NB Ultrasounds cannot diagnose PBC, they can only show any 'mass scarring' of the liver. they are done more as a general check and to rule out other issues.

All sorts of things can cause fluctuations in the LFTS that can render testing for PBC difficult - eg pregnancy - and just having AMAs does not mean that you have PBC, or that you will necessarily develop it.

I would try to improve: health, diet, exercise etc according to the advice given on the 'PBC Foundation' website who host this site (Google, it's free to join and there website and advisors are wonderful).

Also, try to be positive and avoid all stress: always the worst for all autoimmune conditions. Have fun, do things you love: chill, dance, exercise, laugh - whatever rocks you and gets rid of stress: = always good for us!

Take care,

Gritty

[soulshine02 in reply to GrittyReads]

Yes, I have been doing exercise and eating healthy. It is my anxiety that is getting the best of me. My father died of cirrhosis almost 2 years ago. It was alcohol related. My health anxiety went through the roof. Been trying to manage it, but it is difficult.

[GrittyReads]

NB I sorry for typos … plus I really do know the difference between there and their, sorry!

[SunnyXXOO]

Good morning soulshine, just wanted to let you know there are other reasons alt, ast, alk phos to be elevated. I wouldn’t project (will get you in all kinds of trouble), I would try not to worry (easier said then done). Anxieity and stress silent killer.

Love, Peace, Gratitude, and Light,

SunnyXXOO

[soulshine02 in reply to SunnyXXOO]

I agree ! I do have a problem with thinking the worst. My anxiety has been a big problem lately, so I need to get serious and find ways to relax.

[Ellyne]

I had elevated ast and alt like yours. I had positive for AMA M2 and positive for ANA. GGT and ALP both lower end of normal. Had a liver biopsy and the report said rule out other mimics so I got tested for sarcoidosis and that was negative. Took my slide and went for a second opinion and the pathologist said there was indication of early PBC. I have been on Urso for one year and my ast and alt are 17 and 15 now. Had a Fibroscan and that came out negative for stiffness. I know that many feel that the biopsy is no longer as important for diagnosis but I disagree

[soulshine02 in reply to Ellyne]

Thank you for the information. When it comes to our health, it seems we have to be proactive. Especially when dealing with a potential auto immune disease.

[Skypony]

Hi, yes a third vote for GGT testing because it can clarify things. But so far you seem well, so that's a win!

Best wishes

[soulshine02 in reply to Skypony]

Thank you!

[SunnyXXOO]

Hey soulshine, there are other reasons your enzymes are elevated.

Have you ever tried a good CBD for your anxiety, it works like a charm. I use SOL-CBD Original flavor tincture, help with anxiety/sleep etc.....

Look at SOL-CBD, you can mention my name (Sunny), probably get discount.

SOL-CBD is produced in England, great product.

Love, Peace, Gratitude and Light

SunnyXXOO

[soulshine02 in reply to SunnyXXOO]

Yeah, I know a few people who use CBD oil and it helps with their anxiety. I will look into it. Thank you for the information.

[SunnyXXOO in reply to soulshine02]

❇️🙏

[donna01]

I have a friend with this SAME thing going on. She tests positive for AMA, but her ALP, ALT is normal while her AST is about 3 points above normal. Dr's just have her go every 6 months for blood work. She only goes yearly and is going next week so we are curious to see where it's at now. Now, she also has Chrones disease. . Dr is puzzled that she has AMA showing but liver enzymes are normal. He has not put her on any medications yet, but we shall see where her blood work is now. He told her you can show AMA and never get symptoms. Hopefully you're in the same boat! Good luck!