Transaminitis Causes, Differential, Treatment & Statins

The term “transaminitis” is used to mean elevated transaminases. Transaminases are certain liver enzymes, and elevated transaminases, or elevated liver enzymes or transaminitis, can indicate the presence of liver disease. Liver disease may be mild and asymptomatic or it may be severe and life-threatening, but it’s always cause for concern. The functions of the liver are crucial and irreplaceable, and the test for elevated liver enzymes is therefore an important early diagnostic for potential medical concerns.

Enzymes

The liver produces a lot of different enzymes (thousands of them, in fact) that play important roles in digestion and metabolism, but two of them are particularly important for diagnostic purposes. These are aspartate transaminase (AST) and alanine transaminase (ALT). In most occurrences of liver disease, ALT is more highly elevated than AST. The reverse is often the case with alcohol-related liver disease, this being one of the most common single causes of liver disease, but responsible for a minority of cases compared to all other causes combined.

Causes

Many different conditions can cause transaminitis. Some of these causes are forms of liver disease, but others are not. Besides liver disease, possible causes of transaminitis are elevated triglycerides, a condition often accompanying high cholesterol levels. Some medications can  also produce the symptom.

These include some antibiotics, anti-cholesterol drugs (the medication family known as statins), and some drugs used to treat seizure disorders. Besides prescription pharmaceuticals, some herbal supplements can have the same side effects. Although these are not diseases of the liver, they produce the effects they do on transaminase levels by their impact on liver function, and therefore the test indicates a cause for concern and perhaps a need for a change in medication.

Transaminase Differential Diagnosis

When a blood test indicates elevated transaminases (transaminitis), further analysis to determine the ratio of blood AST to blood ALT, as well as a further test for alkaline phosphatase (ALP), allows “differential diagnosis.” It’s important to understand that these are not tests for liver function. Other tests can indicate that, but tests for blood levels of AST, ALT, and ALP do help detect problems with the liver.  Differential diagnosis can help differentiate among various liver diseases that might be indicated by the mere fact that transaminases are elevated above normal level.

Treatment

In fact, since transaminitis despite the form of the word isn’t a disease, there’s no treatment for it. What it is, however, is a possible indicator of liver disease, and treatments should certainly be recommended for that.

As transaminitis can indicate various liver diseases, as well as non-liver-disease causes stemming from medications, environmental conditions, and a variety of other things, further diagnostic procedures to determine exactly what is causing the test results become important. If liver disease is present, it’s important to determine whether it is alcohol-related or not. If it is, then the proper treatment is a reduction in the consumption of alcohol (or cutting out alcohol altogether). If the liver disease results from some non-alcoholic cause, it becomes important to determine whether it is related to obesity, diabetes, infection, or some other cause of liver problems and the treatment should focus on correcting that cause, whatever it is.

When the cause of the test results is a prescription medication, another concern arises. Prescription drugs are used to treat medical conditions and are not something that can simply be ceased without consequences. One must weigh the benefits of the medication against any potential damage it may be causing to the liver, and also consider whether there are effective alternatives to the medication that could provide the same benefit without causing liver problems. Often there is no easy or cost-free solution, and sometimes the risk of liver damage
has to be tolerated and accepted for a time.

Statins

Among the medications that can cause elevated liver enzymes, the statin family of drugs, used to treat high cholesterol, present an especially knotty trade-off situation. Statins have been shown in clinical trials to reduce the risk of cardiovascular disease, which is the number one cause of death in the advanced world. That’s not a small benefit, but a frequent side effect is to cause elevated transaminase levels, especially
ALT and AST, and some physicians have expressed concern that the drugs may be causing liver damage.

In fact, clinical evidence of liver damage resulting from use of statins is very rare. It appears that while there is some evidence that the drugs can cause liver damage, the elevation of transaminases is not a secondary effect of liver damage but arises from another effect of the drugs, probably on liver activity itself. Because of this, and because high cholesterol is considered a very significant health risk, the medical community’s consensus as of today is that high cholesterol should be treated aggressively using statins as well as lifestyle methods, and that moderate amounts of transaminitis –– absent other evidence indicating actual liver damage –– is an acceptable consequence and not a reason to discontinue the medication.