A recent study from the Medical University of South Carolina (MUSC) Digestive Diseases Research Center (DDRCC) explains why doctors should be careful when using a certain liver function test to diagnose alcoholic cirrhosis.
Alcoholic cirrhosis affects about 1 in 400 adults in the United States. It is an advanced form of liver disease, which occurs when chronic use of ethanol causes inflammation and cirrhosis or scarring of the liver. Less than 50% of people diagnosed with advanced liver disease due to cirrhosis survive for a year, so early diagnosis is crucial. Although cirrhosis is not usually a reversible disease, early diagnosis provides an opportunity for doctors to encourage cessation of alcohol use and to offer treatment that can reduce symptoms and increase life expectancy. life.
âThe main message here is that if you just watch the test, you will miss the diagnosis. ”
– Dr Don Rockey, Director of DDRCC
A common method of diagnosing patients with alcoholic cirrhosis is to look for high levels of enzymes called aminotransferases in the liver. However, the MUSC study, published in The American Journal of Medical Sciences, found that patients with alcoholic cirrhosis have nearly normal aminotransferase levels. In this study, the results of liver function tests from 78 patients with alcoholic cirrhosis revealed
The study results are important because doctors who rely solely on these tests may not diagnose alcoholic cirrhosis, said the gastroenterologist at MUSC Health and director of DDRCC. Don Rockey, MD, who led the study.
In his own practice, Rockey often observed that his patients with advanced liver disease had normal results on this test.
âWe were seeing these patients with advanced disease and complications, but their liver tests looked normal. So if you were just going to look at their liver tests, you’d be like, “Oh, no problem,” but it actually wasn’t, “Rockey said.
Often, patients can show subtle signs and symptoms in the early stages of alcoholic cirrhosis. However, if doctors only look at the lab results and not the patient, they are going to be “faked,” Rockey said.
“Doctors need to pay attention to the history, to the physical examination, to the whole clinical picture,” he said.
Doctors also need to be aware of the tools available to diagnose cirrhosis, Rockey said. Non-invasive diagnostic tools include cross-sectional imaging, CT scans, MRIs and most importantly the new technique – elastography. Rockey explained that elastography is a simple, non-invasive, and convenient way to assess liver fibrosis and scarring. This test, available at MUSC and other tertiary care centers, can be easily performed in clinics or at the bedside.
Rockey said the next step is to educate as many vendors as possible and get the word out. Although doctors specializing in gastroenterology can understand that these laboratory tests are not always reliable, it is important to disseminate this information to a wide variety of practitioners.
âThe main message here is that if you just watch the test you will miss the diagnosis,â he said.
Sullivan MK, Daher HB, Rockey DC. Normal or near normal aminotransferase levels in patients with alcoholic cirrhosis. Am J Med Sci. October 4, 2021: S0002-9629 (21) 00355-4. doi: 10.1016 / j.amjms.2021.09.012. Epub ahead of print. PMID: 34619146.