Liver Disease

ACG: Guidelines for Evaluating Abnormal Liver Chemistries

The American College of Gastroenterology recently released new guidelines, the first in 10 years, on the evaluation of abnormal liver chemistries.

The new guidelines include, for the first time in a liver test guideline, definitions of the normal serum alanine aminotransferase (ALT) level ranges for men and women, and recommendations for diagnosing and treating liver diseases.
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“Multiple studies have demonstrated that the presence of an elevated ALT has been associated with increased liver-related mortality. A true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l for females and levels above this should be assessed,” according to the guidelines.

Among the recommendations:

  • Men who consume more than 210 grams of alcohol per week and women who consume more than 140 grams of alcohol per week and have higher levels of serum aspartate aminotransferase (AST) than ALT  should be considered at risk for alcoholic liver disease and receive counseling for alcohol cessation.
  • Screening for alpha-1 anti trypsin deficient with alpha-1 anti-trypsin phenotype is highly recommended for patients with persistently elevated AST or ALT.
  • Patients with abnormal liver chemistries should be asked about prescribed and over-the-counter medications, non-prescribed complementary or alternative medicines, and dietary or herbal supplements that may be associated with drug induced liver injury.
  • Liver biopsy is recommendation if serologic testing and imaging fails to explain a diagnosis, to stage a condition, or if multiple diagnosis are possible.

In addition, the guidelines include algorithms for evaluating abnormalities in alkaline phosphatase and bilirubin levels, and recommend tests for diagnosing hepatitis A, B, and C, and other liver diseases.

“This guideline has been developed to assist gastroenterologists and primary care providers in the interpretation of normal and abnormal liver chemistries as well as an approach to prioritize and evaluate those who present with abnormal liver chemistries,” the authors stated.

—Melissa Weiss

Reference:

Kwo, PY, Cohen SM, and Lim JK. Evaluation of abnormal liver chemistries [published online December 20, 2016]. The American Journal of Gastroenterology. doi: 10.1038/ajg.2016.517.