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Dr. Andrew Rynne

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Mild abdominal pain with elevated sgpt and sgot. Bowel sensitivity due to IBS. Reason for enzyme elevation?

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Practicing since : 1996
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Dear Doctor,
You have seen my entire case history and commented on it. Pls refer my previous history and consultation with you. Now the present problem is given below in detail.

1. I feel sometimes mild pain or vague feeling in the liver area, sometimes it relived of by gas release, is this due to gastritis. Sometimes changing the position immediately gas comes out and pain in liver are goes off. Sometimes bending right side gives same feeling but bending second time at the same time I will not feel the same pain again. Sometimes it stays. Recent gastroscopy shows I have got antral gastritis and all other parameters normal. Some doctors say it is because of no gall bladder I will have such feelings in liver area is that true. You know that all my work on liver is negative expect mild elevation of sgpt and sgot. GE specialist in Pondicherry institute of medical sciences said you liver is not enlarged and ultrasound normal it is not liver pain. It is due to IBS. Is that true? He says liver cannot feel pain. My recent visit to Fortis hospital Bangalore last week GE specialist physically examined and said live is not enlarged so it is not liver pain it is due to something else. May be muscle pain he says. This is not first time complaint, from my GB surgery onwards I have been asking GE specialists the same question they never answered me properly and ignoring this problem. Let me know what causes that feeling in liver area. For your reference recent Ultrasound is quite normal. This is the first and important question.

2. After breakfast sitting in a chair I get feeling of getting bowls. The same complained to Fortis GE doc he said you have got bowl sensitivity due to IBS. Once in two weeks I get the episode of IBS local, GE docs are giving me Enterogerminia and colaspa that’s all. Is there any better treatment for IBS.

3. On net some where I read that who had Gilbert’s and gallstones in childhood should be screened for hemolysis because this combination give gallstones in childhood is this reason for mild elevation of liver enzymes? But my recent CBC is normal.

4. On net some where I read that XXXXXXX disease can evolve at any time, some of the symptoms are migraine headaches and neurological disorders I had those headaches. Is this reason for mild elevation of liver enzymes?

5. If not all can severe vascular migraine attack which lasted for two days, after that I picked up myself only after a month. Do such types of attacks cause mild elevation of liver enzymes? Because we checked Liver enzymes that time, after the episode the enzymes are slowly coming back. Otherwise the severe IBS can cause the mild elevation of liver enzymes?

Thank you.
Tue, 8 Jan 2013 in Digestion and Bowels
Answered by Dr. Ratnakar Kini 17 hours later
Thanks for posting your query and requesting me to answer it.

1. Yes, it could be due to IBS as it is associated with gas also. Liver pain is unlikely as liver is normal in size. Liver pain is felt only when the liver is enlarged (which stretches the covering of liver causing dull pain).

2. Yes, these are symptoms of diarrhea predominant irritable bowel syndrome. You can take VSL#3, Librax and Ibset. Discuss with your doctor about these medications. Get your stool test done to rule out infection. You may also get benefited with a short course of rifaximin along with the other medications I have mentioned above.

3.Gallstones during childhood requires evaluation for hemolysis. But other features like a low hemoglobin and high reticulocyte count will be there. Above all hemolysis increases only the bilirubin levels and not SGOT and SGPT.

4. To be more specific, XXXXXXX Disease can become symptomatic any time between 5-55 years. But the basic problem presents from birth as it is a hereditary/genetic problem. Your siblings also will be affected. In your case XXXXXXX disease has been ruled out as per the information you gave during our previous interaction.

5. Migraine does not cause an increase in the liver enzyme levels. But medications taken for the treatment of migraine can cause it. Similarly IBS ( whether severe or mild) does not cause an increase in the liver enzyme levels.

I hope that answers your question.
If you have no more questions, kindly accept this answer and rate this service.

Dr.Ratnakar Kini
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