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Liver biopsy, IV sedation, general anesthesia, ALT, AST level, no fatty liver. Lupus or autoimmune hepatitis?

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Gastroenterologist, Surgical
Practicing since : 1989
Answered : 883 Questions
Dear Hepatitis Researcher,

I am writing in hopes that you may be able to help me identify locations where I may be able to obtain a Fibroscan in the U.S.

I am a 45 year-old female Caucasian, and I am not in a position to easily obtain a liver biopsy due to extreme sensitivities to multiple local anesthetics tested, and concerns expressed by my doctors regarding IV sedation/general anesthesia without further testing. They have recommended that a non-invasive procedure would be preferable given my particular medical history.

My ALT and AST levels have been elevated for over 20 years, with no evidence of fatty liver in multiple US or MRIs through the years. My physicians are leaning toward the possibility of lupus, lupoid hepatitis, or autoimmune hepatitis diagnosis. To date, testing has ruled out viral hepatitis, celiac disease, rheumatoid factor, and various other causes for the health issues I am experiencing.

I would like to have Fibroscan testing done to potentially assess the degree of liver damage, and/or confirm or rule out NAFLD/NASH as a possible cause for my positive XXXXXXX and so that I can begin an appropriate course of treatment.

I live in Louisiana, and am able to travel easily anywhere in the U.S. that might have the technology available without the typical requirement for a liver biopsy as required in clinical trials. I greatly appreciate any help you can offer in my search for possible providers.

I have added additional information about my condition(s) as tags to this post. Please do not hesitate to contact me in this forum or via PM if you should require any further information as I am limited to the length of my post.

Thank you for your assistance and best regards.
Posted Thu, 19 Apr 2012 in Liver and Gall Bladder
Answered by Dr. Ketan Vagholkar 2 days later
I understand your concern.

A combination of Fibroscan and fibrotest will enable you to quantify the extent of fibrosis of the liver giving the same information as a liver biopsy. This will enable the gastroenterologist to commence further treatment. Another alternative clinical assessment is the Hepa score comprising of the various factors namely, age, gender, bilirubin levels, GGt ( gamma glutamyl transferase), hyaluronic acid and alpha 2 macroglobulin levels.
A newer imaging modality now is acoustic radiation force imaging.
There is a gastroenterologist by name of Dr Afdhal at XXXXXXX Israel Deaconess center in NYC who is conducting a trial of non invasive tests versus invasive liver biopsy in determining the extent of damage in the liver which serves as a road map for further treatment. His email address is YYYY@YYYY .

This facility is also available in the University of Miami. Please contact the Center for Liver Diseases, University of Miami, XXXXXXX M. Miller School of Medicine, Miami for further details. You can contact them at 305-243-UMGI (8644) for further details.

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