The Detection of Minimal Alcoholic Liver Disease by Three Methods

Abstract

The serum aspartate transaminase, 2-h post-prandial bile acids and the aminopyrine breath test were measured in 14 alcoholics with histologically proved minimal liver damage. A raised aspartate transaminase value was found in 64% (9/14) of the patients and was the commonest abnormality found. In three patients all three tests were normal. Six patients stopped abusing alcohol and, when reassessed a mean of 33 days later, showed significant changes in the mean aspartate transaminase value and the mean value for the aminopyrine breath test. There was no significant change in the mean post-prandial bile acids value. The remaining eight patients continued to drink alcohol and, when reassessed at a mean of 118 days, showed no significant change in any of these indices. Of the methods assessed, the serum aspartate transaminase appeared to be the most useful for detecting and monitoring patients with minimal alcoholic liver disease. However, all three tests failed to detect an unacceptably high percentage of the patients, and liver biopsy therefore remains a more certain diagnostic method.

Use of Enzymes for the Diagnosis of Alcohol-Related Organ Damage

“…Therefore, in most of the cases the histological verification of the type and severity of the liver involvement will be nec essary [148,150],…”

Predictive Value of the Concentration in Serum of Total 3α-Hydroxy Bile Acids in the Diagnosis of Hepatobiliary Disease

“…report a nosographic sensitivity of 0.77 for fasting and 0.83 for postprandial serum bile acid concentration in anicteric hepatic disease (23 patients). Kobayashi et al (11) investigated 70 patients with histological signs of hepatic disease, but with normal routine liver function tests, and found a nosographic sensitivity of 0.24 for fasting serum bile acid concentration, whereas Galizzi et al (6) reported that only 5 out of 14 patients with minimal alcoholic liver disease had elevated postprandial serum bile acid concentration, while 9 patients had elevated S-aspartate aminotransferase. The rest of the authors do not say much about how the diagnostic groups were selected, but it is characteristic that hepatic disease, especially the chronic types, most often is verified by biopsy, which therefore may represent a selection.…”

“…The concentration of bile acids in serum is a sensitive test for hepatobiliary disorders in patients with such diseases diagnosed by other means (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). It has been assumed that the concentration of bile acids in serum is also a specific diagnostic test for hepatobiliary disease.…”

“…Furthermore, the patients are tested in the stage of the disease typical for the time of diagnosis.A review of the literature on the diagnostic value of serum bile acids in hepatobiliary disease shows that all investigators have used the classical method of comparing test results in a patient group and a control group. In studies from the past decade(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)25) nosographic sensitivities in hepatobiliary disease from 0.38 to 1.0 (median 0.88, no. = 19) for fasting serum bile acid concentration and from 0.37 to 1.0 (median 0.93, no.…”