Abnormal Liver Enzymes

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.