Natural course of subjects with elevated liver tests and normal liver histology

• DOI: 10.1111/liv.12935
• Publication Date: 2015-08-10T09:04:07Z
• Authors: Michael Strasser; Andreas Stadlmayr; Heike Haufe; Felix Stickel; Peter Ferenci; Wolfgang Patsch; Alexandra Feldman; Daniel Weghuber; Christian Datz; Elmar Aigner
• Keywords: Adult; Male; Alcohol Drinking; Liver Diseases; 610 Medicine & health; Middle Aged; Weight Gain; 3. Good health; Hepatitis, Autoimmune; 03 medical and health sciences; 10219 Clinic for Gastroenterology and Hepatology; 0302 clinical medicine; Liver; Liver Function Tests; Risk Factors; Austria; Humans; 2721 Hepatology; Female; Liver Diseases, Alcoholic; Follow-Up Studies

AbstractBackground & AimsLiver biopsy (LB) is performed if non‐invasive work‐up of liver disease is inconclusive. The examination of liver tissue occasionally reveals normal histology. Long‐term follow‐up of such patients has not been performed.MethodsWe identified a total 70 subjects from our LB database with elevated liver tests and normal liver histology after a mean of 90.5 ± 52.3 (range 15–216) months and conducted reassessment of medical history, physical examination, laboratory testing, ultrasound, transient elastography and LB if indicated.ResultsAt follow‐up examination, 15 (7 females (f)/8 males (m); 21.4%) subjects had normal liver tests and no further evidence of liver disease. A subset of 37 (29 f/8 m; 52.9%) subjects had persistently elevated liver tests without evidence indicating progressive liver disease but the cause thereof remained unexplained also at the follow‐up visit. Three (0 f/3 m; 4.3%) subjects had consumed excessive alcohol with indicators of alcoholic liver disease. Eleven subjects (4 f/7 m; 15.7%) had developed steatosis on ultrasound examination along with weight gain and/or biochemical features of the metabolic syndrome. In addition, three (2 f/1 m) patients developed autoimmune hepatitis, one female presented with primary biliary cirrhosis. One male was diagnosed with cholangiocellular carcinoma 3 months after the initial evaluation.ConclusionThe clinical course of most patients was benign, but in approximately 20% of the subjects a liver disease developed. Particular attention should be given to autoimmune liver diseases in subjects with positive autoantibodies. In addition, lifestyle factors such as weight gain and alcohol consumption were associated with the manifestation of liver diseases.