title: [Liver enzymes elevation: etiologic study and efficiency of a single-act office visit].
abstract: BACKGROUND
  Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit.
  
  
  METHODS
  From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist.
  
  
  RESULTS
  A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients.
  
  
  CONCLUSIONS
  The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started.
authors.affiliation: Servicio de Aparato Digestivo, Hospital Torrecárdenas, Almería, España. alvarobendezu@hotmail.com
authors.forename: Rogger Álvaro
authors.initials: RÁ
authors.lastname: Bendezú García
authors.forename: Marta
authors.initials: M
authors.lastname: Casado Martín
authors.forename: Marta
authors.initials: M
authors.lastname: Lázaro Sáez
authors.forename: Gustavo Óliver
authors.initials: GÓ
authors.lastname: Patrón Román
authors.forename: Alejandra
authors.initials: A
authors.lastname: Gálvez Miras
authors.forename: Gonzalo P
authors.initials: GP
authors.lastname: Rodríguez Laiz
authors.forename: Mercedes
authors.initials: M
authors.lastname: González Sánchez
authors.forename: José Luis
authors.initials: JL
authors.lastname: Vega Sáenz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood*; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008107:Liver Diseases / Q000097:blood* / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D000637:Transaminases / Q000097:blood*; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D000637:Transaminases; D000469:Alkaline Phosphatase
keywords: Consulta de acto único; Enzimas hepáticas; Hígado graso no alcohólico; Liver enzymes; Non-alcoholic fatty liver disease; Single-act office visit; Transaminasas; Transaminases