Liver Function Test - elevated ALT

[InkyStinky]

Hi everyone!

I had a liver function panel done last week – I have a crazy doctor situation because my GP is in town and my GI is an hour and a half away, so I have my labs done in town and they send the results to my GI. On Friday my GP’s nurse called to tell me one of my liver enzymes is “a little high” and that I needed to be in touch with my GI for "his recommendation". So I called my GI first thing yesterday morning and I still haven’t heard back. I was a bit concerned (I’ve never had an elevated liver test before that I know of) so I got a copy of the results from my GP:

Liver Function Panel
AST: 32 (Range: 5-34)
ALT: 91 (Range: 7-40)
Albumin Serum: 4.6 (Range 3.5-5.0)
Alkaline Phosphatase: 41 (35-123)
Bilirubin, total, female: 0.6 (Range: 0.1-1.2)
Protein, total, serum: 6.8 (Range: 6.4-8.3)
Bilirubin, direct: 0.2 (Range 0-0.2)

The ALT has me worried because I’m on 6mp – 75mg/day (I never had any liver enzyme trouble when I took it in the past). But I’m also on a very high dose of Warfarin (blood thinner; alt. days of 12.5/15mg), so I’m wondering if that has anything to do with it. Anyway, is an ALT of 91 really “just a little high” like my GP’s nurse said – 91 when the range only goes to 40 seems really high to me!

Thanks for any advice you can give me - it's really stressing me out waiting to hear from my GI!

 

[Misty-Eyed]

Hi Inky,

Please don't worry too much. Once mine came back as 478! My GP was really freaking out and took me off of everything right away (I was on methotrexate) although my GI wasn't as worried. Apparently they'd been 'slightly high' previously, only they'd never told me or thought it bad enough to take me off the methotrexate.

He just ran tests to make sure it was nothing else, took me off of the methotrexate and ordered an ultra sound to look at my liver. My liver was fine on the ultrasound and so they are just keeping an eye on it now.

So please don't worry if mine were that high and I'm still alive! See what your GI says and good luck!

 

[InkyStinky]

Thanks Misty-Eyed, that does help. I'm trying not to worry but over the past few months (since I found out I have blood clots) it seems that the treatments for Crohn's and clots are at loggerheads, and I am worried that if the blood thinner and 6mp are both elevating my ALT that I'll have to stop the 6mp (as I can't stop the blood thinner). I know there are other drug options, but 6mp worked so well for me before... I guess I feel "safe" with it. :ytongue:

Thanks again!

---Sabrina

 

[Misty-Eyed]

No problems

I know the feeling though. Methotrexate really worked for me too. I've had crohn's for so long and I've been on almost everything at some time or another. Luckily I'm not too ill at the moment or I'd be worried about finding a new drug. We'll see how it goes though.

There are so many treatments though that I'm sure you'll find something else if they want to talk you off the 6mp. You never know, they may just want to keep an eye on the liver function tests to see how it goes for a bit like I did. I was just none the wiser at the time!

 

[Sue-2009]

Yeah, ditto with Misty Eyed...Mine have come back high..and I freaked out...but my GI has good experience with meds and is in touch with liver specialists...She told me to chill, and stuff leveled off...But, GP's generally I don't think have the experience the GI has...So good luck... Let us know what happens...Love your by line Sue

 

[kasper87]

90? naaaah don't even worry. I had mine go through the roof with TPN, they forced me to get off and Get a PICC line removal..

It went down later in the week..

6-mp can do it to. I'd take it easy. Don't worry about it

 

[InkyStinky]

Thanks so much you guys - I feel a lot better now. Which is good because I didn't hear from my GI's office today (grrrr!). You folks are the best!

---Sabrina

 

[bethyd78]

mine have been slightly elevated also. I've been told Pentasa can do it also

 

[Crohn's 35]

Hey Sabrina, I know you are worried and I understand. When I was on Mercatopurine, my liver was affected within a week. I have been on prior meds, and I guess switching to another just overloaded it. I know now I cannot take immunosuppressives. Sometimes test are botched or not accurate. I know I could tell you not to worry but you will, it is only human to be when you dont have answers right away.

Please let us know what he says, I am curious, hang in there a tad longer. :confused2:

 

[soupdragon69]

Hey Sabrina,

Totally understand why you are concerned but it will resolve itself once you are off the meds.

Sometimes all it really takes is a slightly lower dose to drop the elevated levels and so you might be able to stay on the meds.

Thats where your GI comes in and hopefully they get back to you soon!

As long as you dont have any symptoms like constant severe nausea that is different to what you might "normally" suffer or extreme exhaustion as another example then they may well continue the drug.

Keep us posted on how you are and the outcome with your GI.

Thinking of you ((hugs))

 

[InkyStinky]

Thanks Pen and Jan - I *still* haven't heard from my GI (argh!), but I'll let you know what he says as soon as I hear from his office. I really want to call them again, but I don't want to look like "that crazy patient" :yrolleyes: If I don't hear anything this afternoon I am going to call first thing tomorrow, though, because he does procedures on Fridays and I'm not going to worry about this all weekend!

 

[InkyStinky]

As long as you dont have any symptoms like constant severe nausea that is different to what you might "normally" suffer or extreme exhaustion as another example then they may well continue the drug.

Thanks, Jan, it really helps to know what to look for. Right now I just have my "normal" nausea and fatigue :ytongue: so I'm hoping everything will be ok!

 

[InkyStinky]

Nothing from my GI's office yet, even though I called again this morning and left yet another message with a nurse (not "my" nurse, though, which makes me wonder if the messages are even getting through!). Grrr... this is frustrating! By the time I hear from his office my blood work is probably going to be so out of date that they'll have to redo it... and start this whole cycle again!:runaway:

David in Seattle posted the paper "Hepatobiliary Associations with Inflammatory Bowel Disease" (http://www.crohnsforum.com/showthread.php?t=9747), and I found this part interesting:

Monitoring of serum aminotransferase levels is essential in all patients on AZA/6-MP, regardless of TPMT activity and metabolite levels. Patients who have an asymptomatic, slight increase in liver tests early in the treatment course should be continued on the drug at the current dose with close monitoring of biochemistries to ensure resolution. In a nonjaundiced patient with moderate-to-severe elevations in serum aminotransferase levels (5 × ULN), the medication dose should be decreased by 50%.[5] If the chemistries normalize, the dose may be escalated back to the original dose; however, if they remain abnormal, the drug should be discontinued. If the serum aminotransferase levels remain abnormal after discontinuation of the drug, a liver biopsy should be considered.

 

[Creepy Lurker]

I currently have an elevated enzyme, although I can't remember which of the two it is.

I'm told that as long as it's only one of them, then there isn't really much to worry about.

Oddly enough, my GI thinks it's possibly Omeprazole that's causing it.

 

[InkyStinky]

I'm told that as long as it's only one of them, then there isn't really much to worry about.

Thanks, that's good to hear... especially because after 2 weeks and *4* calls to the office I still haven't heard from my GI! I don't know if I should laugh or scream. I talked to his nurse this morning, and she said she'd ask him about this *today*... still waiting...

I'm so thankful for you guys! If it weren't for you I'd be totally stressing out over this.

 

[InkyStinky]

Update

Saw my GI a couple weeks ago - sorry I didn't post sooner, but I'm so fatigued I can hardly function. Anyway, I had my gp ck my liver levels before seeing my GI, and the ALT was down to 60ish. My GI said not to worry unless it's consistently in the hundreds, and get it checked every 3mths. Just thought I'd update this incase anyone was wondering.

 

[ataloss]

glad to hear its down! i just saw your post but was gonna tell you not to sweat it. just one barely up like that is nothing. glad all went well.

 

[Manzyb]

Hey there! I am having a bit of the same problem. My liver enzymes have been elevated for about 5 months now. My GI said that it could be because of all the inflammation I have right now, and that can cause the bile ducts not work properly all of the time. I am going to have something called MRCP done next week were they are going to check the liver and bile ducts to see what's going on. I too was a little weird about it at first, but I'm sure it will all be fine.

I'm glad that your levels went back down, and I hope you are feeling well.

Amanda

 

[Mountaingem]

Me too-the highest the ALT got was 150, not sure if MTX or Remicade caused it, it's now down to 50 which the doc said is on the "high" side of normal.*sigh*