Q. I have chest pain and acid reflux with raised AST and ALT levels. Kindly explain.

Answered by
Dr. Ajeet Kumar
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Jun 26, 2020 and last reviewed on: Jul 22, 2020

Hello doctor,

I recently went to the ER for persistent and sharp chest pain. It was diagnosed as a bad acid reflux spell but was told to follow up with a GI doctor in case it was an ulcer. The doctor noted slightly high protein levels but I am looking at my chart and I have high AST and ALT levels. Is this cause for concern?



Welcome to

I can understand you must be concerned and very upset about your recent onset symptoms and visit to ED for this chest pain. Yes, they are right, that you might have ulcers in the food pipe that has led to chest pain. But you see, the patients with ulcers in food pipe, often have a chronic history of acid reflux and heartburn before they develop ulcers and have significant chest pain because of it.

On the other hand, the ulcer pain or pain due to just acid reflux not necessarily mean that the ulcer can immediately subside with the Famotidine type of medications which suppress acid production within the stomach.

Having said that, the raised AST and ALT are an unusual findings, and in fact may the actual cause underlying your recent development of chest pain and visit to ED. Your ALT and AST are almost x10 times than the normal ranges given your age and gender (attachment removed to protect patient identity). This suggest that you have ongoing inflammation within the the liver. Such high levels of ALT and AST can causes different symptoms within human body, notably, the fatigue, loss of appetite, weakness, acidity, vomiting, and fever. The potential causes underlying such high level of ALT and AST are Paracetomol use in toxic doses or acute viral infections like Hepatitis A, hepatitis E and Hepatitis B infections. Autoimmune hepatitis (AIH), mushroom poisoning and lastly alcohol induced hepatitis.

For me to help you diagnose your case, I would need more information before I can make an impression of one of above causes and then can suggest you some target investigations to confirm the reason underlying deranged ALT and AST. I would urge you to provide more information, as we can shrink the list of differentials and can confirm the cause by relevant investigations. And lastly to treat it appropriately. It is possible that you may need some time for observation (such as in Paracetamol poisoning and alcohol related liver inflammation and some viral infection like Hepatitis A infection); or may need some more close monitoring and start of treatment (such as hepatitis B, mushroom poisoning, and Autoimmune hepatitis).

Investigations to be done:

Will recommend relevant testing after detailed information is provided.

Treatment plan:

For now, just avoid Paracetamol if you were taking, and any other medication which is supposed to damage the liver. Famotidine is fine.

Regarding follow up:

Follow up to provide more information.

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