Transaminitis

“Transaminitis” is a term that means elevated levels of certain liver enzymes, which are called “transaminases.” Elevated liver enzymes can be an indicator of liver disorders, although they can also indicate other things. Liver disease is always reason for medical concern, although in some cases and in the early stages of progressive diseases it may not have any overt symptoms. The liver is one of the most crucial organs of
the body and one of the most complicated. A breakdown of liver function is always fatal without aggressive treatment up to and including a liver transplant, so early detection of liver disease is very important. It allows treatment that can arrest the progression of the disease and in some cases reverse the damage. Blood tests for transaminitis are important tools for early detection of liver disease before any symptoms occur.

Liver Enzymes

The liver is the source for literally thousands of enzymes. Enzymes are chemical substances that act as catalysts, amplifying or accelerating chemical reactions. Enzymes aid in digestion and metabolism of foods, and in many other bodily functions. Of all the enzymes produced by the liver, four or five are of particular importance diagnostically, and of those four or five two stand out and are more frequent targets of testing than any other. Those two are alanine transaminase (ALT) and aspartate transaminase (AST). A test for blood concentration of ALT is usually the first indicator of liver disease, with other blood tests and other diagnostic procedures (such as medical imaging) used to follow up and pin down exactly what is causing the elevated levels of ALT in the blood.

Causes

Transaminases can be elevated for many different reasons. Not all of these have anything to do with liver disease. Other causes of transaminitis include high cholesterol, certain medications, and herbal supplements. (Very commonly, the statin family of cholesterol-reducing drugs cause elevated transaminases as a side effect.) Even when the tests are not in fact revealing liver disease, elevated  transaminases are always a cause for concern, as they either indicate damage to the liver or else another problem that may be of great concern (e.g. elevated AST is a sign of heart disease). Even when the cause is a side effect of medication, the effect may indicate a need to change the medication or the dosage being used.

Symptoms

There are no symptoms of transaminitis as such. In fact, the great benefit of blood tests for elevated transaminases is the ability to detect liver disease when there are no overt symptoms, which is usually the case in the early stages even of potentially life-threatening conditions such as cirrhosis of the liver or liver cancer.

Transaminase Differential Diagnosis

A follow-up test commonly used when elevated ALT is found is the differential diagnosis, which involves testing for levels of AST and ALT and calculating a ratio between the two. A third test for alkaline phosphatase (ALP) is often used in conjunction with these. Differential diagnosis can often help to determine what sort of liver disease is present. For example, if AST is present in double or greater the  concentration of ALT, this is a common indicator of hepatitis (swelling of the liver, often but not always viral in origin), while an elevation of ALT above that of AST is more likely to show liver cancer.

Treatment

Transaminitis is not actually a disease, and so there is no treatment for it as such. As an indicator of liver disease and other health problems, it’s a good diagnostic for success of treatments aimed at arresting and reversing the diseases that it indicates.

Further diagnostic procedures are always indicated when tests for transaminitis show a positive. These can include other blood work, medical imaging techniques such as ultrasound to visually inspect the liver for such things as fatty deposits and fibrous growths, and a biopsy of the liver to test for cancer, viral infections, and cirrhosis. In addition, a survey of the patient’s lifestyle is an important diagnostic tool. The most common single cause of liver disease is alcohol abuse, so inquiries into the amount of alcohol a patient consumes daily is useful to identify (or rule out) this problem. Other causes of liver disease include obesity, diabetes, viral infections, and side-effects of medication. Identifying the cause of the disorder is the key to treatment, as treatment usually involves correcting the cause to arrest or reverse the damage.

When transaminitis arises from a side effect of prescription drugs, one must be careful about treatment; the drugs are prescribed to treat problems that may themselves be serious. This is different from alcoholic liver disease in that cutting out alcohol has no deleterious effects, but cutting out drugs being used to treat a dangerous medical condition very well might! The benefit of the medication has to be weighed against the damage it may be causing to the liver. When there are effective alternatives to the drugs that won’t have this side-effect, of course that indicates a desirable course of action.

Transaminitis And Statins

One particularly common instance of transaminitis resulting as a side-effect of medication arises with the use of the statin family of drugs which are standard treatments for high cholesterol. Clinical trials have demonstrated that statins reduce the risk of cardiovascular disease –– easily as dangerous an illness as liver disease, and in fact the number one killer in the advanced world. Because the drugs frequently cause transaminitis as a side effect, however, some physicians became concerned in the past that they could be damaging the liver in the course of reducing the risk of a heart attack, and that would not be a net improvement.

Follow-up studies have however shown that actual liver damage from statins is rare. Although some evidence indicates that the drugs can cause damage to the liver, the common side-effect of transaminitis doesn’t arise from liver damage in most cases but from an effect of the drugs on liver activity itself, causing elevated levels of transaminases and so a false indicator of liver damage or liver disease. As a result, the consensus of the medical community today is that high cholesterol should be treated aggressively with both lifestyle changes (these same lifestyle changes acting to reduce the risk of liver disease as well, since the same risk factors often apply to both that and cardiovascular disease) and medications.