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What do my lab test results indicate?

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Posted on Mon, 9 May 2016
Question: Since September I have had high liver enzymes. Prior to September my Alt was 30 and my ast was 19. Now my Alt is fluctuating and the Ast is still in normal range. My last 6 Alt readings are as follows: 72, 53, 120, 76, 48, and 76. I had an abdominal ultrasound performed and the liver appeared normal with no signs of fatty infiltration. I also have crohns and have been on humira for 9 Years and Asacol for 14 years. My GI doesn't think it's related to the meds. I have been tested for all hep viruses and autoimmune disease and everything is negative. he wil not do a biopsy unless the numbers go greater than 3 times the upper limit of normal. He is having me try 2 supplements milk thistle and nac to see if it can help bring the numbers down. I think one of my meds is causing it but not sure which one. I also have high ldl cholestrol which is why we thought possible fatty liver but the normal ultrasound proves otherwise. is there anything else I can do to help bring the numbers down?
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Answered by Dr. Panagiotis Zografakis (6 hours later)
Brief Answer:
nothing more you can do besides investigation

Detailed Answer:
Hello,

i don't know why your doctor does not believe that it's the drugs because both of your drugs may cause liver enzyme elevation. Actually almost any drug may do that but some drugs do so more often than others. If you've done all the necessary tests and everything is negative then only a biopsy might help diagnostically. Since you don't have any problems (symptoms or serious enzyme disorders) perhaps the biopsy is not the best choice right now.

Make sure that your doctor has tested you for causes like Wilson's disease, hemochromatosis, celiac disease, OTC drugs or supplements, etc for which the patients may -sometimes- not be tested. If everything has been investigated completely then it has to be the drugs.

Mild elevations (less than three times the higher normal limit) are acceptable if the drug is considered effective. Higher elevations constitute a good reason to seek alternatives. You can't do anything more besides investigating for the cause. When the cause has been identified, specific treatment can be given.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Panagiotis Zografakis (10 minutes later)
are you familiar with supplements such as nac or milk thistle? do you think it's worth a try to see if it helps?
doctor
Answered by Dr. Panagiotis Zografakis (8 minutes later)
Brief Answer:
not familiar but they're not documented treatment options

Detailed Answer:
I'm not familiar with them but I can assure you that none of them is a documented treatment option for any disease. NAC may help liver metabolism and milk thistle is supposed to help with liver problems but their effects have not been tested (at least not adequately). I do believe it's the drugs that caused this elevation...

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3767 Questions

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What do my lab test results indicate?

Brief Answer: nothing more you can do besides investigation Detailed Answer: Hello, i don't know why your doctor does not believe that it's the drugs because both of your drugs may cause liver enzyme elevation. Actually almost any drug may do that but some drugs do so more often than others. If you've done all the necessary tests and everything is negative then only a biopsy might help diagnostically. Since you don't have any problems (symptoms or serious enzyme disorders) perhaps the biopsy is not the best choice right now. Make sure that your doctor has tested you for causes like Wilson's disease, hemochromatosis, celiac disease, OTC drugs or supplements, etc for which the patients may -sometimes- not be tested. If everything has been investigated completely then it has to be the drugs. Mild elevations (less than three times the higher normal limit) are acceptable if the drug is considered effective. Higher elevations constitute a good reason to seek alternatives. You can't do anything more besides investigating for the cause. When the cause has been identified, specific treatment can be given. I hope you find my comments helpful! You can contact me again, if you'd like any clarification or further information. Kind Regards!