Laboratory test results can often be alarming, particularly when we see unfamiliar terms and values marked with an asterisk that fall outside the normal range. One such common abnormality is an elevated level of liver enzymes. Many people immediately assume the worst, even though there are numerous, easily treatable causes behind abnormal liver enzyme levels. In this article, we use a patient’s story to explain what abnormal liver enzyme levels mean, what the possible causes might be, and how investigation and treatment are carried out in accordance with the latest principles of gastroenterology, with particular regard to future diagnostic and therapeutic options.
What is a liver enzyme abnormality and why is it important?
Liver enzymes are proteins found in liver cells that play a key role in the body’s metabolic processes. If liver cells are damaged or become inflamed for any reason, these enzymes are released into the bloodstream and their levels rise in laboratory tests.
The most commonly tested liver enzymes:
- GOT (glutamate-oxaloacetate transaminase) or ASAT (aspartate aminotransferase): This enzyme is found not only in the liver, but also in the heart, muscles and other organs.
- GPT (glutamate-pyruvate transaminase) or ALAT (alanine aminotransferase): This enzyme is much more specific to the liver, so an increase in its levels usually indicates a liver problem.
- GGT (gamma-glutamyl transferase): Its levels most commonly rise in cases of alcohol consumption or problems with the bile ducts.
- AP (alkaline phosphatase): As well as in the liver, it is also found in the bones and the bile ducts.
It is important to note that a slight increase in liver enzymes does not necessarily indicate a serious illness. The aim of the investigation is to identify the cause of the increase and determine the necessary course of action.
A typical case: Katalin’s story
Katalin, a 52-year-old office worker, underwent a routine occupational health check-up. Her lab results showed a slight increase in her GPT and GGT levels, marked with an asterisk. Katalin was alarmed, as she did not drink alcohol regularly and was not aware of any chronic illnesses. The occupational health doctor recommended a specialist gastroenterological examination. The Endomedix Gastroenterology Centre During her appointment with her specialist, Katalin said that she had been feeling more tired of late and sometimes experienced an unpleasant, tight sensation beneath her right ribcage, but she put this down to her stressful lifestyle.
The gastroenterologist carried out a thorough interview about his lifestyle, dietary habits, medication and any family history of illness. He then ordered an abdominal ultrasound scan.
The path to diagnosis: the toolkit of modern gastroenterology
The first step in the examination is always to take a thorough medical history and carry out a physical examination. The specialist’s aim is to rule out the most common causes.
1. Abdominal ultrasound:
In Katalin’s case, the abdominal ultrasound scan revealed a „brighter” liver, i.e. hepatic steatosis (fatty liver). This is a condition in which an abnormal amount of fat accumulates in the liver cells. This is the most common cause of elevated liver enzymes in the Western world.
2. Further laboratory tests:
Following the diagnosis of fatty liver, the doctor requested further tests to identify any underlying conditions:
- Virus serology: To rule out hepatitis B and C viral infections. These chronic infections can also cause liver damage and elevated enzyme levels.
- Autoimmune panel: Certain autoimmune diseases (e.g. autoimmune hepatitis) can attack the liver. To detect these, specific antibodies are tested for in the blood.
- Metabolic tests: Measurement of blood glucose and insulin levels, and testing for insulin resistance and blood lipids (cholesterol, triglycerides) to rule out metabolic syndrome.
- Iron budget: Haemochromatosis (iron overload disease) is an inherited condition which can also lead to liver damage.
Katalin’s test results confirmed insulin resistance and slightly elevated cholesterol levels. This made the diagnosis clear: Katalin’s elevated liver enzymes were caused by non-alcoholic fatty liver disease (NAFLD), which had developed as a component of metabolic syndrome.
Diagnostics of the future: FibroScan and genetic tests
Gastroenterology is constantly evolving. Non-invasive (non-surgical) procedures are now available that allow the extent of liver damage to be accurately assessed.
- FibroScan (transient elastography): This painless, ultrasound-based test can measure the stiffness of liver tissue, which indicates the extent of scarring (fibrosis). Fatty liver can lead to fibrosis and, in the long term, to cirrhosis. FibroScan helps to assess this risk without the need for a liver biopsy (tissue sample).
- Genetic markers: Research is identifying an increasing number of genetic factors that predispose people to certain liver diseases. In the future, genetic screening carried out using a simple blood test could help to identify high-risk patients at an early stage, enabling targeted prevention.
Treatment and long-term care
Having established Katalin’s diagnosis, the doctor recommended a comprehensive lifestyle change programme, which forms the basis of treatment for non-alcoholic fatty liver disease.
The cornerstones of treatment:
- Diet: The most important thing is to follow a low-carbohydrate, low-fat diet. Avoiding refined carbohydrates (white flour, sugar) and saturated fats, and eating fibre-rich foods (vegetables, whole grains) is essential. The Mediterranean diet is particularly recommended.
- Regular physical activity: At least 150 minutes of moderate-intensity physical activity per week (e.g. brisk walking, cycling, swimming) is recommended. Physical activity improves insulin sensitivity and helps with weight loss. Even a weight loss of 5–10% can significantly improve liver function and laboratory test results.
- Medication: There is currently no specific medication for fatty liver, but treating comorbidities such as diabetes or high blood lipid levels is crucial. In Katalin’s case, the doctor also started her on medication to treat insulin resistance.
What can we expect in the future?
As science advances, the treatment of fatty liver and other chronic liver diseases is becoming increasingly targeted.
- New medicines: A number of clinical trials are currently underway involving active substances that directly target the inflammatory and scarring processes occurring in the liver. The first medicines specifically designed to treat inflammation caused by fatty liver (NASH) are expected to become available within a few years.
- Personalised therapy: In future, based on genetic and other biomarkers, doctors will be able to draw up personalised treatment plans tailored to each patient’s individual risk profile.
Katalin attended a follow-up examination six months later. Thanks to her lifestyle changes, her weight had dropped by 8% and her liver enzyme levels had returned to normal. She felt much more energetic, and the discomfort she had been experiencing under her right rib cage had completely disappeared. Her story is a good example of how abnormal liver enzyme levels are an important warning sign which, if recognised in time and taken seriously, can help prevent more serious illnesses.
When abnormal liver enzyme levels indicate a more serious condition
It is important to note that, although fatty liver is the most common cause, elevated liver enzymes may also be caused by other, more serious conditions, such as:
- Chronic viral hepatitis (B, C): They can now be effectively treated with vaccines or modern medicines.
- Autoimmune liver diseases: They require immunosuppressive treatment.
- Inherited diseases: Such as Wilson’s disease or haemochromatosis.
- Drug-induced liver injury (DILI): Certain medicines, and indeed some herbal remedies, can cause liver damage.
- Bile duct obstruction: Due to gallstones or a tumour.
For this very reason, it is essential that any abnormalities in liver enzyme levels are always investigated by a specialist, a gastroenterologist.
A Guide to the Future
If you notice elevated liver enzyme levels on your lab results, don’t panic, but don’t ignore them either! The most important thing is to consult a gastroenterologist. The Endomedix Gastroenterology Centre Our experienced specialists use state-of-the-art diagnostic methods to help identify the causes and draw up a personalised treatment plan. Early detection and appropriate treatment are key to maintaining long-term liver health. With your active involvement and the help of modern medicine, most liver diseases can now be successfully treated, thereby preventing serious complications.
