Journal of General Internal Medicine

, Volume 34, Issue 9, pp 1675–1675 | Cite as

Abnormal Liver Enzymes

  • Shih-Wei LaiEmail author
Letter to the Editor

One study by Bian et al. examined the follow-up patterns of abnormal liver enzymes in primary care.1 The authors reported that no association between race and follow-up patterns after an initial abnormal liver test, but approximately 50.7 to 56.5% of people with abnormal liver enzymes did not perform a repeating test.1 In addition, Schreiner et al. reported that 11.7% of people with abnormal liver enzymes did not perform a repeating test during the study period.2 Malakouti et al. reviewed that abnormal liver enzymes might only be a normal physiological variation in some people, but it might reflect potential pathological changes in other cases and need further evaluation and management.3 The most common causes of pathologic changes are disorders of hepatocellular injury and disorders of cholestasis.3,4 A review of Agganis et al. disclosed that the three most common etiologies of abnormal liver enzymes are alcoholic toxicity, medication overdose, and fatty liver disease.4 Agganis et al. emphasized that even asymptomatic, any people having abnormal liver enzymes should receive further investigations including a detailed history taking and physical examination, followed by appropriate laboratory testing and other diagnostic workup.4 Therefore, the potential underlying causes can be found. The American College of Gastroenterology recommends a practice guideline regarding the evaluation of abnormal liver enzymes.5 This guideline is easily understood and performed in clinical practice. Primary care clinicians serve as the first-line healthcare providers and they should keep this guideline in mind.


Compliance with Ethical Standards

Conflict of Interest

The author declares that there is no conflict of interest.


  1. 1.
    Bian J, Schreiner AD, Zhang J, Schumann SO, Rockey DC, Mauldin PD, et al. Associations of race with follow-up patterns after initial abnormal liver tests in primary care. J Gen Intern Med. 2018;33(10):1618–20.Google Scholar
  2. 2.
    Schreiner AD, Moran WP, Zhang J, Kirkland EB, Heincelman ME, Schumann Iii SO, et al. Evaluation of liver test abnormalities in a patient-centered medical home: do liver test patterns matter? J Investig Med. 2018;66(8):1118–23.Google Scholar
  3. 3.
    Malakouti M, Kataria A, Ali SK, Schenker S. Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do? J Clin Transl Hepatol. 2017;5(4):394–403.Google Scholar
  4. 4.
    Agganis B, Lee D, Sepe T. Liver enzymes: No trivial elevations, even if asymptomatic. Cleve Clin J Med. 2018;85(8):612–7.CrossRefGoogle Scholar
  5. 5.
    Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18–35.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.College of Medicine China Medical UniversityTaichungTaiwan
  2. 2.Department of Family MedicineChina Medical University HospitalTaichungTaiwan

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