Therapeutic Suggestions in Occult Chronic Hypertransaminasemia

Less than 25% of asymptomatic adults have elevated levels of transaminases on a first evaluation, one third of these patients have normal values on a retest. From those who have elevated ALT on retest, some prove to suffer from an acute liver disease (with normal ALT in less than 6 months), and the others represent the category of chronic (more than 6 months) elevation of transaminases. The etiology of chronic hypertransaminasemia can be elucidated in 90% of the cases, due to liver disease with occult/ atypical evolution, or extra-hepatic causes of chronic elevation of transaminases. The 10% left represent the category of unexplained (obscure cause) elevation of transaminases. The occult/atypical evolution liver diseases are represented by chronic viral hepatitis (HBV, HCV), alcohol consumption, non-alcoholic steatohepatitis (NASH), congestion liver, drugs and liver toxic substances, autoimmune hepatitis, Wilson's disease, α1 antitrypsin deficiency, parasitic diseases. The extra-hepatic causes that can determinate chronic elevations of transaminases are haemolysis, soft muscle diseases (polymyositis), occult celiac sprue, suprarenal insufficiency, thyroid pathology. There still remains 10% of the patients in witch the etiology can not be explained. Usually these patients are kept under surveillance, periodic reevaluation, and undergo a second liver biopsy; witch may reveal nonspecific lesions, NASH, chronic hepatitis, cirrhosis. There are cases in witch on the surveillance period it was observed a spontaneous normalization of transaminases. Chronic hypertransaminasemia is quite frequent, and has a high addressability to the physician from patients with this type of pathology, being for most of them a discovery by chance on a routine blood check. It is also important to have a clear diagnosis to start the specific treatment for those patients who can benefit out of it as soon as possible.