Transaminitis: Causes, symptoms, and treatments

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Transaminases play key roles in the liver. They help the organ’s cells to function, break down substances, and remove toxins from the body.

When a person has elevated levels of these liver enzymes, there may be no apparent cause, and levels often return to a normal range without treatment.

However, transaminitis can be associated with serious conditions. It is important to explore why levels are high and diagnose any underlying issue.

Common causes and treatments

According to the American Academy of Family Physicians, the following factors can lead to elevated levels of transaminases:

  • nonalcoholic fatty liver disease
  • alcoholic liver disease
  • viral hepatitis
  • hemochromatosis
  • certain medications

Transaminitis is less commonly caused by:

  • alpha-1 antitrypsin deficiency
  • autoimmune hepatitis
  • Wilson’s disease
  • other health conditions

Nonalcoholic fatty liver disease

This condition develops when there is too much fat in the liver cells, and up to 30 percent of adults in the United States may have it.

Risk factors include obesity and high cholesterol, but the exact cause is unknown. There are often no symptoms when the disease is at an early stage, but some people experience fatigue or mild pain in the upper-right area of the abdomen.

Continual damage can eventually lead to scarring, or cirrhosis, which significantly impacts the liver’s function.

The following strategies can prevent or help to combat fatty nonalcoholic liver disease:

  • eating a healthful, balanced diet
  • exercising regularly
  • maintaining a healthy weight

Alcoholic liver disease

Damage caused by excessive consumption of alcohol leads to this condition, which is also called alcohol-related liver disease.

In early stages, there are typically no symptoms. In later stages, symptoms include:

  • blood in the stool or vomit
  • confusion
  • drowsiness
  • jaundice (yellowing) of the skin and eyes
  • nausea
  • a swollen abdomen
  • swollen ankles
  • weight loss

A study published in 2010 included 256 participants with mild transaminitis. Alcohol consumption was reportedly the cause of fatty liver disease in 10 percent of cases.

It is essential to give an accurate report of alcohol consumption. Otherwise, it can be difficult for a doctor to distinguish between these types of liver disease with a biopsy or other simple diagnostic tools.

Treatment for alcohol-related liver disease involves abstaining from alcohol and making lifestyle changes similar to those recommended for people with nonalcoholic fatty liver disease.

When alcohol-related liver disease is severe, a person may require medication or a transplant.

Viral hepatitis

Hepatitis refers to a type of liver inflammation. It is commonly caused by a viral infection, usually hepatitis B or hepatitis C.

The following are symptoms of both types of infection:

  • abdominal pain
  • dark urine
  • fatigue
  • fever
  • jaundiced skin and eyes
  • joint and muscle pain
  • a loss of appetite
  • nausea
  • vomiting

Both types of infection can last for a few weeks or develop into serious lifelong conditions. Only about 6–10 percent of adults and older children infected with hepatitis B develop a chronic condition. However, most people develop chronic hepatitis C once infected.

Treatment for short-term hepatitis infection involves:

  • resting
  • staying hydrated
  • managing symptoms

Chronic infections are monitored and treated with antiviral medications. Untreated viral hepatitis can cause early, permanent liver damage.

Hemochromatosis

This disease causes too much iron to build up in the body. It is stored in organs such as the liver, heart, and pancreas, where it can contribute to problems such as liver disease and diabetes mellitus.

Hemochromatosis may be hereditary, or it can develop as a result of other conditions, including types of anemia and chronic liver diseases.

People with this disease tend to start experiencing symptoms between the ages of 40 and 60. Symptoms include:

  • fatigue
  • impotence
  • joint and abdominal pain
  • a loss of libido
  • problems with the heart, liver, and pancreas
  • general weakness

Treatment involves regularly drawing blood to reduce the levels of iron, which circulates in the bloodstream. This process is called phlebotomy.

Medications and herbs

Medications, supplements, and herbs can impact the health of the liver because it processes these products.

Several medicines are known to cause transaminitis. They include:

  • antidepressants, such as bupropion (Wellbutrin)
  • antibiotics, such as isoniazid (Nydrazid)
  • pain relievers, including acetaminophen (Tylenol)
  • nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin)
  • antifungals, such as ketoconazole (Nizoral)
  • muscle relaxants, such as baclofen (Lioresal)
  • blood pressure-reducing medications, such as losartan (Cozaar) and lisinopril (Zestril)
  • immune suppressants, such as methotrexate
  • the antidiabetic drug acarbose (Precose)
  • the heart medication amiodarone (Cordarone)

Herbal preparations containing the following ingredients may also lead to transaminitis:

  • kava kava
  • germander
  • chaparral
  • senna
  • ephedra

Also, high doses of vitamin A can damage the liver.

If medications or supplements are leading to elevated levels of transaminases, a doctor may recommend reducing the dosage or switching treatments.

Some people may need regular blood tests while taking medications to ensure that they are not interfering with the liver or its enzyme levels.

To diagnose transaminitis, a doctor will take a full medical history and perform a physical examination. They may also order blood tests, and a person will need to fast before these.

The blood tests will determine levels of:

  • glucose
  • iron
  • ferritin
  • total iron-binding capacity
  • hepatitis B surface antigen
  • hepatitis C virus antibody

If levels are normal, a doctor will recommend lifestyle changes and ask the person to attend regular checkups until levels of transaminases go down.

Sometimes, further testing is required. These tests may involve ultrasound imaging, or they may check for levels of blood antibodies.

If levels of transaminases remain high for 6 months, the doctor may order a biopsy.

Home remedies for prevention

To prevent transaminitis:

  • Eat a balanced diet.
  • Engage in moderate physical activity on a regular basis.
  • Maintain a healthy weight.
  • Seek prompt treatment for viral infections.
  • Control chronic conditions, such as diabetes mellitus or autoimmune hepatitis, by following a prescribed treatment plan.
  • Take the recommended dosages of supplements and medicines.
  • Discuss alternative options, if medications are causing elevated levels of transaminases.

Takeaway

A temporary increase in liver enzymes is not unusual. Often, this situation can be resolved by making lifestyle changes.

The outlook depends on the cause of transaminitis. When a viral infection or chronic infection is responsible for raised levels of transaminases, it is important to work with a doctor to reduce levels and prevent further damage to the liver.

Receiving a diagnosis and treatment early will help to keep symptoms manageable and reduce the risk of complications.

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