Comparative Study of Serum Gamma Glutamyltransferase, 5’ Nucleotidase and Alkaline Phosphatase in Icteric and an-Icteric Biliary Disease Patients

Introduction: Diagnostic enzymology plays a useful role in evaluation of various hepatobiliary diseases and numerous enzymes have been compared in different disorders. Among these, significance of Gamma Glutamyl Transferase and 5’ Nucleotidase over Alkaline Phosphatase has been stressed repeatedly, but mainly in the icteric obstructive biliary disease patients. In this study, these three enzymes were compared not only in the icteric but also the an-icteric biliary disease patients, particularly to look for elevation and significance of these enzymes in the latter group. Methods: The study was conducted on 50 biliary disease patients, who were further divided into an-icteric (32 patients) and icteric (18 patients) subgroups depending on their bilirubin levels. 50 subjects matched for age and sex with the study group were enrolled for the control group. Gamma Glutamyl Transferase, 5’Nucleotidase, Alkaline Phosphatase and bilirubin levels were evaluated in all the patients as well as the control subjects. Results: All three enzymes showed a significant rise in the icteric subgroup (p value < 0.001). However, in the an-icteric subgroup, only Gamma Glutamyl Transferase and 5’Nucleotidase showed a significant rise. The rise was more for Gamma Glutamyl Transferse (1.60 times normal, p < 0.001) as compared to 5’Nucleotidase (1.39 times normal, p < 0.01). Conclusion: Gamma Glutamyl Transferase and 5’Nucleotidase are useful for evaluation of not only obstructive biliary disease patients but also for the patients with biliary disease who are an-icteric, and out of these two, the former is a more valuable diagnostic indicator in such diseases.