Elevation of liver enzymes

Question

Dear expert team,

Because of partly increased liver enzymes (AP / GGT) I get the drug ursodeoxycholic acid 400mg. The results for ALAT and ASAT are in the normal range.
What does the intake of this drug effect? Do the liver enzymes return to normal range?
Should probably a biopsy of the liver be done, like the CF-doctor advised me to do?

Thank you

Answer

Hello,
due to the genetic defect (high exposition of CFTR in the bile ducts) some CF patients get complications in the region of the liver and the bile ducts (hepatopathy). In this connection an elevation of liver enzymes is observed. In such a case, firstly an ultrasound of the upper abdominal organs should be performed. If further diganostic measures will be done, depends normally on the detected results and the underliying complaints and should always be decided specifically in the individual case. A biopsy of the liver is seldom necessary in CF. Frequently, there is an elevation of liver enzymes in CF patients without essential changes in the ultrasound of the liver and without any clinical correlation (no complaints).
The therapy of a hepatopathy is difficult. At this, one has to pay attention to a sufficient nutrition, an optimization of the digestion of fat and the intake of fat-soluble vitamins. The indication for the therapy with ursodeoxycholic acid is made generously, which leads to a liquefaction of the bile and which improves the flowing off of the bile. As a rule, a therapy with ursodoxycholic acid is initiated when there are findings in the ultrasound of the liver and/or when there is an elevation of liver enzymes (recommended dosage: 20 - 30 mg/kg/d, whereby 1/3 is given in the mornings and 2/3 in the evening).
URSO has a beneficial effect on liver enzyme levels (whether they may return to normal, cannot be predicted). In addition, some studies have provided indications for positive effects of URSO the bioavailibility of dietary lipids and lipid soluble vitamins, and on weight gain, but this deserves further investigation as not all studies could confirm the improvement of the nutritional status due to a therapy with URSO. Studies that show long-term effedcts on the prevention of liver fibrosis are lacking.

Yours sincerely,
Yours Dr. C. Smaczny

24.11.2008