Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients

OBJECTIVES: It is currently recommend to perform a liver biopsy for patient s with chronically elevated liver function tests (LFT) of unknown etiology (marker negative). The necessity and benefits of these recommendations are unknown. The aims of this study were to determine the prevalence of marker- negative LFT in patients referred for evaluation of chronically elevated LF T; to determine the prevalence of diseases that may be associated with mark er-negative abnormal LFT; and to assess whether a liver biopsy alters the m anagement of such patients. METHODS: We conducted a prospective observational study of 1124 adults refe rred for evaluation of chronically elevated LFT. Patients who consented to a liver biopsy were eligible. Marker-negative abnormal LFT was defined as t he absence of accepted serum markers for infectious, metabolic, autoimmune, or hereditary liver disease, the absence of a history of alcohol or hepato toxic drug use, and the absence of signs of chronic liver disease. RESULTS: Eighty-one of 1124 eligible patients were marker-negative. Liver b iopsies in the 81 marker-negative patients revealed: normal histology (eigh t), steatosis(41), steatohepatitis (26), fibrosis (four), and cirrhosis (tw o). All 73 abnormal liver biopsies had some degree of steatosis. There were no significant associations between histological findings and the presence of obesity (p = 0.13), hyperlipidemia (p = 0.4), or diabetes (p = 0.9). Th ere were no significant associations when classifying patients by gender or by symptoms. CONCLUSION: In the setting of marker-negative elevated LFT, the most likely histological diagnosis is fatty metamorphosis of the liver with occasional associated fibrosis. (C) 1999 by Am. Coll. of Gastroenterology.