Transaminitis - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Transaminitis is a condition characterized by an elevated level of a group of enzymes called transaminases. The causes include alcohol-related liver disease and non-alcoholic fatty liver disease. It is not a disease but points to other conditions that require treatment.

What Is the Pathophysiology of Transaminitis?

The liver performs more than 500 functions that are necessary for the body’s functioning. Among the many functions, some most important functions of the liver include the following:

• Production of blood components.

• Digestion.

• Metabolism.

• Cholesterol production.

• Hemoglobin production.

• Detoxification of harmful substances.

• Regulating blood clotting.

• Regulating blood glucose levels.

• Defense against disease-causing pathogens.

The two most important enzymes or chemicals that help the liver carry out its functions are alanine transaminase (ALT) and aspartate transaminase (AST), together called transaminases. High blood levels of one or both enzymes are called transaminitis. Transaminitis, also called transaminasemia, itself is not a disease but a condition that occurs due to certain diseases, medicines, supplements, or substance abuse. Therefore, high levels of transaminases in the bloodstream are used as a tool to detect the underlying conditions that can raise the levels.

An increase in the level of transaminases that persists for a period of less than six months is referred to as acute transaminitis. If the elevated transaminase level persists for more than six months, then it is called chronic transaminitis.

What Are the Causes of Transaminitis?

Injury or inflammation of the liver cells can cause excess production of transaminases, which enter the bloodstream. Transaminitis can occur due to a variety of conditions, transaminitis causes include,

1. Non-Alcoholic Fatty Liver Disease (NAFLD):

NAFLD is a condition in which high levels of fat accumulate in the liver of people who do not consume alcohol. It is the most common cause of transaminitis in the US (United States) population, accounting for 25 percent of the cases. Few cases of NAFLD can progress to severe liver diseases like scarring (cirrhosis) of the liver or liver failure. The common reasons why NAFLD develops can be :

• High levels of fat (triglycerides) in the blood.

• High blood sugar, especially in people with prediabetes or type 2 diabetes.

• Insulin resistance, in which the body cells do not take up insulin.

• Obesity.

2. Alcoholic Liver Disease (ALD):

Alcoholic liver disease refers to a group of diseases that occur due to alcohol consumption. Excess alcohol can damage the cells of the liver. Alcoholic liver disease can further lead to more severe inflammation of the liver tissue, called steatohepatitis, which can worsen cirrhosis and liver failure.

However, the occurrence of ALD does not depend on the amount of alcohol consumption. Heavy drinkers sometimes do not develop ALD, whereas people who drink moderately can develop the condition.

3. Viral Hepatitis:

Viral hepatitis is liver inflammation caused due to a virus. The three most common types of hepatitis include:

• Hepatitis A: It is a highly contagious viral infection that occurs due to the ingestion of contaminated food and water in very small quantities. Most people recover without serious illness; however, the condition can last from a few weeks to a few months. The hepatitis A vaccine is available for children between the ages of 12 to 23 months and is also available to people who are willing to take it.

• Hepatitis B: Hepatitis B spreads through body fluids like blood and semen, causing liver infections and liver cancer. It is routinely given to infants and children.

• Hepatitis C: Hepatitis C is a mild infection lasting for a few weeks; however, most people develop a chronic infection that lasts lifelong. No vaccine is available for hepatitis C. 8 to 12-week medication courses can cure hepatitis C in up to 90 percent of patients.

4. Non-Viral Hepatitis:

Alcoholic hepatitis and autoimmune hepatitis are the two common causes of hepatitis that do not occur due to viruses. Alcoholic hepatitis occurs due to excess consumption of alcohol, whereas the autoimmune type occurs due to the destruction of the liver cells due to the body’s immune cells.

5. Viral Infections:

Viral infections like infectious mononucleosis and cytomegalovirus (CMV) infection can cause transaminitis. Infectious mononucleosis is a disease caused as a result of the Epstein-Barr virus, which causes sore throat, fever, and extreme tiredness. CMV infection is the most common harmless infection that causes sore throat, fever, and tiredness.

6. Genetic Conditions:

Inherited genetic disorders like hemochromatosis (a condition with excess iron in the body), Wilson’s disease (increased copper accumulation in the body), and celiac disease (a disorder caused due to gluten ingestion) can also cause transaminitis.

7. Medications and Herbal Supplements:

Supplements like vitamin A, medications like over-the-counter pain medicines such as Acetaminophen (Tylenol), heart medications like Amiodarone (Cordarone), and cyclic depressants like Desipramine (Norpramin) can cause transaminitis.

What Are the Transaminitis Symptoms?

Transaminitis as a condition does not cause any symptoms; however, symptoms occur due to underlying liver problems, which include:

• Nausea and vomiting.

• Fatigue.

• Fever.

• Appetite loss.

• Abdominal pain.

• Itching.

• Jaundice (yellowish skin discoloration due to elevated bilirubin levels).

• Dark or tea-colored urine.

• Light-colored stools.

How Is Transaminitis Diagnosed?

Doctors diagnose transaminitis based on physical examination and noting down the medical history of the patient. Also, routine blood tests are ordered, which help detect high levels of liver enzymes.

Blood tests are recommended in the following situations:

• Part of routine blood tests is done yearly.

• Risk of liver disease.

• Symptoms of liver disease.

• For monitoring the treatment of liver disease.

The blood test reports determine levels of:

• Iron.

• Ferritin.

• Total iron-binding capacity.

• Hepatitis B surface antigen.

• Hepatitis C virus antibody.

If the above readings are within range, doctors may recommend lifestyle changes and regular checkups until the transaminase levels come down. Transaminitis ultrasound scans may be advised in a few cases.

What Are Transaminitis Treatment Options?

As transaminitis is a condition, management depends on treating the underlying cause. Doctors recommend following the below steps which include:

• Refraining from alcohol use.

• Losing weight.

• Regular exercise.

• Following a healthy diet by restricting the intake of processed foods, red meat, trans fat, and foods high in sugars.

• Taking recommended medicines and supplements.

• Monitoring the liver function.

• Going for prompt treatment for viral infections.

• Keeping a check on chronic conditions like diabetes by following a proper treatment plan.

• Asking for alternative medicines if medications are the cause.

• Taking the necessary vaccines for protection against hepatitis A and B.

Conclusion:

Transaminitis is a condition that occurs due to elevated blood levels of enzymes called transaminases released by the liver. The increased levels can be due to a serious underlying cause. Therefore, the outlook of the condition depends on the cause. Viral or chronic infections have to be promptly treated to prevent damage to the liver. Early diagnosis and the start of treatment can help manage symptoms and reduce complications.