Current recommendations to do liver biopsy for all patients with chronic transaminase elevations are based on studies that predated hepatitis C virus (HCV) testing. The purpose of this study was to determine the prevalence of serious histologic findings in a cohort of asymptomatic patients who had chronic transaminase elevations but who had negative serologic evaluations.
In a retrospective review, 43 asymptomatic patients who had liver biopsy from January 1991 to December 1992 were identified. All had an aspartatate aminotransferase value exceeding the upper limit of normal. Transaminase elevation was the predominant abnormality. All tested negative for hepatitis B surface antigen, HCV Ab, and antinuclear antibodies and had normal levels of iron, normal total iron-binding capacity, and normal ferritin, otxantitrypsin, and ceruloplasmin levels. Clinical and pathologic records were examined for age, sex, risk factors for hepatitis, alcohol use, transaminase levels, and histologic results.
The cases of 43 patients (39 male, 4 female, mean age 39) were studied. Thirty-two (74%) patients (group 1) had no significant histologic findings; findings included steatosis (22 [69%]) and hepatocellular unrest (17 [53%]). Eleven (26%) patients (group 2) had significant histologic findings, including cirrhosis and/or fibrosis (6 [55%]), chronic active hepatitis alone (1 [9%]), 0r chronic persistent hepatitis alone (4 [36%]). There were no differences between groups 1 and 2 with respect to any of the clinical parameters studied. From this we concluded that liver biopsy enables the practitioner to detect unsuspected serious disease in one fourth of patients whose clinical and laboratory evaluations are unremarkable and that clinical parameters do not help predict the likelihood of serious underlying liver disease. Therefore, liver biopsy is a necessary procedure in the evaluation of liver disease.
By Thomas J. Duntemann, MD, John M. Lawson, MD, David M. Dresner, MD, Richard B. Peterson, MD, Walter J. Coyle, MD, and Richard L. Nemec, MD. Naval Medical Center, Portsmouth, Va
Gastroenterology.., Vol. 87, Southern Medical Journal, 09-01-1994, pp S41.