question about liver enzymes

[Guest guest]

My son was first diagnosed with PSC and UC a year ago when all his

liver enzymes were very high,and the ERCP confirmed the PSC.

He has spent the year trying to get his colitis under control and after

dropping 50 pounds and not responding to all the typical medications,

his diarrhea and weight loss seem to be starting to respond to humira.

He had a blood test done in Dec. (he had been off all drugs for a month

and hadn't started humira or urso yet) and all the liver enzymes are

normal on that blood test. Is that typical that they would fluctuate

from very high to normal . . . or might his changes to his diet be

actually helping.

Do PSC patients often have liver enzymes return to normal levels?

[Guest guest]

Dear " svo5015 " ;

There have been reports of liver disease improvement in celiac patients

when they are put on a gluten-free diet. So when you ask about ... " or

might his changes to his diet be actually helping? " , I am wondering

whether the dietary changes you made included a gluten-free diet?

________________

Clin Rev Allergy Immunol. 2009 Feb;36(1):62-70.

Pathogenesis and clinical significance of liver injury in celiac

disease.

Volta U

Department of Gastroenterology and Internal Medicine, University of

Bologna, S. Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna,

Italy, uvolta@....

Abnormalities of liver function are one of the manifold extraintestinal

manifestations of celiac disease. Although the spectrum of liver

manifestations associated with celiac disease is particularly wide, two

main forms of liver damage namely, cryptogenic and autoimmune, appear

to be strictly related to gluten-sensitive enteropathy. The most

frequent finding is represented by a cryptogenic hypertransaminasemia,

observed in about a half of untreated celiac patients, as an expression

of a mild liver dysfunction with a histological picture of nonspecific

reactive hepatitis (celiac hepatitis) reverting to normal after 6-12

months of a strict gluten-free diet. In a few cases, when celiac

disease is diagnosed, a more severe liver injury, characterized by a

cryptogenic chronic hepatitis or liver cirrhosis, is present. In these

patients, liver damage can still improve after a gluten-free diet

institution. Moreover, a close association between celiac disease and

autoimmune liver disorders has been widely demonstrated. Indeed, celiac

disease has been found in 3-7% of patients with primary biliary

cirrhosis, in 3-6% with autoimmune hepatitis, and in 2-3% with primary

sclerosing cholangitis. Differently from cryptogenic liver injury,

autoimmune liver dysfunction, found in celiac disease, does not usually

improve after a gluten-free diet. Presently, it is difficult to

establish if the two main kinds of liver injury found in celiac disease

(cryptogenic and autoimmune) are discrete entities with a different

pathogenesis or if they are an expression of the same disorder where

genetic factors and the duration of gluten exposure may determine the

severity and the pattern of liver injury. PMID: 18496773.

________________

Another thought .... when they initally did an ERCP on your son at

diagnosis, did they possibly open up a bile duct stricture, which then

allowed bile flow to be restored, and liver biochemistry to improve?

I suppose that it is always possible that a stricture could resolve

spontaneously, giving the same result (i.e. liver enzymes returning to

normal).

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

>

> My son was first diagnosed with PSC and UC a year ago when all his

> liver enzymes were very high,and the ERCP confirmed the PSC.

> He has spent the year trying to get his colitis under control and

after

> dropping 50 pounds and not responding to all the typical medications,

> his diarrhea and weight loss seem to be starting to respond to humira.

>

> He had a blood test done in Dec. (he had been off all drugs for a

month

> and hadn't started humira or urso yet) and all the liver enzymes are

> normal on that blood test. Is that typical that they would fluctuate

> from very high to normal . . . or might his changes to his diet be

> actually helping.

> Do PSC patients often have liver enzymes return to normal levels?

>

[Guest guest]

Dear " svo5015 " ;

There have been reports of liver disease improvement in celiac patients

when they are put on a gluten-free diet. So when you ask about ... " or

might his changes to his diet be actually helping? " , I am wondering

whether the dietary changes you made included a gluten-free diet?

________________

Clin Rev Allergy Immunol. 2009 Feb;36(1):62-70.

Pathogenesis and clinical significance of liver injury in celiac

disease.

Volta U

Department of Gastroenterology and Internal Medicine, University of

Bologna, S. Orsola Malpighi Hospital, Via Massarenti 9, 40138, Bologna,

Italy, uvolta@....

Abnormalities of liver function are one of the manifold extraintestinal

manifestations of celiac disease. Although the spectrum of liver

manifestations associated with celiac disease is particularly wide, two

main forms of liver damage namely, cryptogenic and autoimmune, appear

to be strictly related to gluten-sensitive enteropathy. The most

frequent finding is represented by a cryptogenic hypertransaminasemia,

observed in about a half of untreated celiac patients, as an expression

of a mild liver dysfunction with a histological picture of nonspecific

reactive hepatitis (celiac hepatitis) reverting to normal after 6-12

months of a strict gluten-free diet. In a few cases, when celiac

disease is diagnosed, a more severe liver injury, characterized by a

cryptogenic chronic hepatitis or liver cirrhosis, is present. In these

patients, liver damage can still improve after a gluten-free diet

institution. Moreover, a close association between celiac disease and

autoimmune liver disorders has been widely demonstrated. Indeed, celiac

disease has been found in 3-7% of patients with primary biliary

cirrhosis, in 3-6% with autoimmune hepatitis, and in 2-3% with primary

sclerosing cholangitis. Differently from cryptogenic liver injury,

autoimmune liver dysfunction, found in celiac disease, does not usually

improve after a gluten-free diet. Presently, it is difficult to

establish if the two main kinds of liver injury found in celiac disease

(cryptogenic and autoimmune) are discrete entities with a different

pathogenesis or if they are an expression of the same disorder where

genetic factors and the duration of gluten exposure may determine the

severity and the pattern of liver injury. PMID: 18496773.

________________

Another thought .... when they initally did an ERCP on your son at

diagnosis, did they possibly open up a bile duct stricture, which then

allowed bile flow to be restored, and liver biochemistry to improve?

I suppose that it is always possible that a stricture could resolve

spontaneously, giving the same result (i.e. liver enzymes returning to

normal).

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

>

> My son was first diagnosed with PSC and UC a year ago when all his

> liver enzymes were very high,and the ERCP confirmed the PSC.

> He has spent the year trying to get his colitis under control and

after

> dropping 50 pounds and not responding to all the typical medications,

> his diarrhea and weight loss seem to be starting to respond to humira.

>

> He had a blood test done in Dec. (he had been off all drugs for a

month

> and hadn't started humira or urso yet) and all the liver enzymes are

> normal on that blood test. Is that typical that they would fluctuate

> from very high to normal . . . or might his changes to his diet be

> actually helping.

> Do PSC patients often have liver enzymes return to normal levels?

>