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Suggest treatment for non-alcoholic steatohepatitis

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Posted on Thu, 17 Dec 2015
Question: Hello Doctor, I was diagnosed with XXXXXXX last year (elevated levels of SGPT, SGOT and GGT and obesity). I repeated my LFT yesterday and while SGPT and SGOT was still elevated (259 and 104) GGT became normal but direct bilirubin increased to 0.33 and total bilirubin was 1.22. ALP is below normal (at 35) while albumin and globulin are within range. Why do u think the direct bilirubin increased and is there anything to be concerned about?
doctor
Answered by Dr. Prof. Kunal Saha (2 hours later)
Brief Answer:
Your ongoing ailment is the cause of rise in direct bilirubin.

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through the details. Non alcoholic steato hepatitis (NASH) itself is the cause of the elevation of direct bilirubin. However, I do not think that there is anything to be worried about. We are more concerned with GGT and ALP and since they are normal (below normal is absolutely fine), you need not worry. Just maintain a balanced lifestyle and follow the regular directives of your doctor. Nothing else needs to be done.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (50 minutes later)
Dear Doctor,

Thank you for your answer. My doctors have basically asked me to reduce my weight substantially and follow a balanced diet (like you suggested). Do you think this will solve the problem? Also for monitoring purposes after how long should one get a repeat test done.
doctor
Answered by Dr. Prof. Kunal Saha (0 minute later)
Brief Answer:
Weight reduction measures are indeed helpful.

Detailed Answer:
Thanks for writing back. Your doctors have given you the right suggestion. XXXXXXX is characterized by elevation in blood lipid levels. Hence the lipid of fat deposits need to be countered. In other words, weight reduction measures are very essential. Although that will not solve the problem, it will definitely keep the problem in control.

I am not in favour of monitoring routinely. Rather, remain in periodic follow up of your doctor and follow his advice.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (22 minutes later)
Thank you Doctor. I guess a repeat after 4 months should be sufficient. Also, regarding wight loss, i either tend to lose weight very quickly or dont lose at all. My doctor says that it is not good to lose weight quickly and it should be gradual over a period of time. But i am unable to hold on to that commitment for that long. What is the way out?

Also, a direct bilirubin of .33 is that within referal range or above normal?
doctor
Answered by Dr. Prof. Kunal Saha (25 minutes later)
Brief Answer:
Be consistent in regular exercise and diet plan.

Detailed Answer:
You need to be consistent in regular exercise and diet plan. That is the only way out. As regards the direct bilirubin level, it is practically in the normal range.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (3 hours later)
Thank you Doctor,

I had the following follow up question:-

a) My next appointment with my doctor is after 2 months. Should I prepone this to show these reports? or this can wait.

b) My albumin is 4.7 and Globulin is 3.5. I understand Globulin is right on the upper edge. Is this something to worry about?

c)Based on your experience will weight loss improve my LFT or something else needs to be done as well.
doctor
Answered by Dr. Prof. Kunal Saha (3 hours later)
Brief Answer:
You need not worry.

Detailed Answer:
Thanks for writing back.

a) I do not see any requirement to prepone the appointment based on these reports alone. This can wait. You can repeat the tests shortly before the next appointment.

b) That the globulin level is at a decent level indicates that your immune system is working properly. It is not something to worry about, rather its assuring.

c) Regular exercise, morning walk as well as a well maintained diet should help in reducing your weight as well as improve your lipid profile reports. I do not see requirement of anything else.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (1 hour later)
Thank you doctor.

I have been told that XXXXXXX may lead to cirrohsis. Is that true?

If yes how much time does it take and what are the early symptoms ? At this stage do I need to worry about cirrhosis ?
doctor
Answered by Dr. Prof. Kunal Saha (2 hours later)
Brief Answer:
It is true

Detailed Answer:
Yes, XXXXXXX has high likelihood of progressing to cirrhosis. So, you need to be cautious. It is hard to predict how much time it may take for such a development. As of now, you need not worry about cirrhosis. Just try to maintain a decent lifestyle with exercise and proper diet as for weight loss.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (15 hours later)
Hello Doctor,
I am a little worried about Cirrohsis and was wondering whether to get a Prothrombin time test done as it is also a good marker. My friend thinks i am overdoing this and should concentrate on my work. I must admit that i have been treated (cognitive therapy) for Hypochondriasis before. What are your thoughts
doctor
Answered by Dr. Prof. Kunal Saha (31 minutes later)
Brief Answer:
Relax. There is still much of life to live. Live everyday before you die.

Detailed Answer:
I understand your anxiety but I do not feel your anxiety to be valid. Are you anxious that someday you would die (since all men die sooner or later). If you have a fear of death to such an extent that it is affecting your daily work, it is definitely not justified even though the basis is not irrational. This is what is called hypochondriasis. What is wrong is the weightage that you are attaching to the situation.
Similar is the case of your worries related to getting cirrhosis. Even though there is a reasonable possibility of your getting cirrhosis later in life, there is no point making your life miserable at this point of time. Besides, the possibility that you never get cirrhosis also remains. Unless you make that clear to yourself, no amount of cognitive therapy would help you.
So, all I would ask you to do is to relax and not to bother about things that you have no control over.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (3 days later)
Thank you doctor.

My doctor had asked me to get a HBA1C and a Serum Insulin done. While HBA1C came at 5.3 serum insulin was at 25.26 (normal is less than 25). What are your thoughts?

I did get the PT/INR done (my idea) and it came as 1.04 INR.

Are we completely sure that there is no cirrohsis
doctor
Answered by Dr. Prof. Kunal Saha (2 hours later)
Brief Answer:
The levels are fine

Detailed Answer:
Your HbA1c levels are not indicative of diabetes. I would not be bothered about the insulin level in your case. The PT-INR are normal and not something to worry about.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4469 Questions

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Suggest treatment for non-alcoholic steatohepatitis

Brief Answer: Your ongoing ailment is the cause of rise in direct bilirubin. Detailed Answer: Thanks for asking on HealthcareMagic. I have gone carefully through the details. Non alcoholic steato hepatitis (NASH) itself is the cause of the elevation of direct bilirubin. However, I do not think that there is anything to be worried about. We are more concerned with GGT and ALP and since they are normal (below normal is absolutely fine), you need not worry. Just maintain a balanced lifestyle and follow the regular directives of your doctor. Nothing else needs to be done. Regards