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Natural course of subjects with elevated liver tests and normal liver histology
Author(s) -
Strasser Michael,
Stadlmayr Andreas,
Haufe Heike,
Stickel Felix,
Ferenci Peter,
Patsch Wolfgang,
Feldman Alexandra,
Weghuber Daniel,
Datz Christian,
Aigner Elmar
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12935
Subject(s) - medicine , liver biopsy , autoimmune hepatitis , gastroenterology , fatty liver , transient elastography , liver disease , steatosis , alcoholic liver disease , histology , physical examination , primary biliary cirrhosis , hepatitis , liver function tests , pathology , cirrhosis , biopsy , disease
Background & Aims Liver 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. Methods We 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. Results At 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. Conclusion The 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.