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Raised Liver Enzymes and UC

Introduction:

My name’s Mike, I’m 32 and I live in the UK. I was diagnosed with UC in December 2011 after suffering with symptoms that were dismissed by my doctor as IBS for a year and a half.

After a bad flare up just after my diagnosis, I was put on Pred, and eventually stepped down completely after 6 months. I’m now taking 3g Pentasa.

Some more about me:

I’m a freelance web designer and love my job. I’m keen to meet other people with UC and to raise awareness of IBD in general.

My Symptoms:

After my most recent colonoscopy in September 2012, I was told I was now in remission, however, I still get some urgency and discomfort. Thankfully things are far better than they were, but still not as good as they could be, and my specialists think a change of drug might help.

Raised Liver Enzymes and UC

Hey everyone. I actually count myself as one of the lucky UC’ers, as my story has been pretty straightforward so far. After going through a terrible flare up a year ago (lots of blood, 10-20 BMs a day) Pred pretty much sorted me out, and Pentasa seems to be keeping me more or less in remission. I still occasionally get some blood, urgency and fatigue, but thankfully nothing like during my flare up. I’ve found that I can eat a pretty varied diet, with a few exceptions – nothing spicy or too greasy. My family have been great, and my girlfriend has given me so much support during this period. I’ve found care in the UK to be a bit hit and miss, some specialists have been great, others not so good, the main problem has been trying to see the same person twice in a row at my IBD clinic, which I find so important with a condition as personal as this.

Anyway, after getting my main symptoms more under control, the main issue I have now is with my liver. My specialist has noticed that my blood results have shown really high levels of liver enzymes, and they have consistently risen each time I’ve had blood tests (which has been roughly every three months since my diagnosis in 2011.) I’ve had an ultrasound on my liver, which didn’t show any abnormalities, and I’ve also recently had an MRI which I’m still waiting to hear the results from.

What I’m wondering is has anybody else had similar issues with their livers and UC? I’m just trying to get an idea if high enzyme levels are normal with this disease, and what they could be a sign of. I don’t think they are connected with any particular medication, as they were raised on my first blood test taken before I started taking UC drugs, but while I was inflamed.

written by Mike H

submitted in the colitis venting area




20 Responses to Raised Liver Enzymes and UC

  1. Angela March 25, 2013 at 6:13 am #

    Hi Mike,

    Yes I do! Actually, my UC is a side effect disease of my liver problem. I have what’s called Type 1 Autoimmune Hepatitis (my immune system attacks my liver). It’s more rare in men, but doesn’t mean you shouldn’t be checked out. Type 1 is characterized by the presence of a secondary autoimmune disease (like UC). Your liver enzymes would be up with it. The only way to diagnosis it, however, is blood work and a liver biopsy. If it’s not treated it’ll keep getting worse. Here’s some info on it. Might be worth a shot to have the blood work done to see.

    http://digestive.niddk.nih.gov/ddiseases/pubs/autoimmunehep/

    It’s treatable with medications on and off. They have to treat you with immunosuppressors. 6-mp (while not working for my UC) sent my AH into remission within a year and being one remicade now for 9 it’s been in remission ever since. Even enjoy an occasional glass of wine. Had the disease for 11 years.

    I hope you figure it out!

    • MJH
      Jeanne October 21, 2013 at 12:38 pm #

      Hi Angela,
      I was also diagnosed with Auto Immune Hepatitis (AKA auto-immune cholangitis (AMA)). Mine is treated with ursodeoxycholic acid (Ursodiol) pretty effective, well under control. I do blood work every 3 months to monitor. For UC I take Salofalk.

  2. joanna March 25, 2013 at 9:01 pm #

    high liver enzymes are pretty common for UC. i had them when i was diagnosed, too. they got worse on my UC meds but they are back to normal since i got off of them.

    i ended up getting an ultrasound as well as an MRCP test done on my liver and both were normal. not sure why UC stresses the liver but my guess is that since our body has high inflammation, it makes the liver have to work harder to do everything. it has SOOO many functions like:

    storing iron
    processing hemoglobin
    regulating blood clotting
    removing bacteria
    producing immune factors
    bile production
    glycogen storage

  3. Mike H March 26, 2013 at 3:38 am #

    Thank you very much for your replies, Angela and Joanna.

    I just had an appointment at my IBD clinic last week, and finally found out a little bit more about my MRCP. Apparently the results weren’t conclusive, although they were consistent with inflammation, which doesn’t really tell me much! However, taking the results into account, together with the raised enzymes and fatigue, the specialist brought up the possibility of Primary Sclerosing Cholangitis. This really shocked me, as I’ve read some real horror stories about this condition and although I’d heard of the link between PSC and UC it had never been mentioned as a possibility for me before.

    Anyway, I’m due for more blood work and then a possible biopsy in the next three months to try and work out what’s going on.

    My enzyme levels in January 2012 were:

    ALT 81 u/l
    ALP 129 u/l
    Gamma GT 171 u/l

    Unfortunately I don’t have my most recent results handy.

    • joanna March 26, 2013 at 3:31 pm #

      yeah, PSC is what my doctor thought i had, too. it definitely does sound scary since you end up needing a liver transplant. the MRCP should’ve been able to detect it. liver biopsies are very unliable since they only pull out a tissue sample from one part of the liver. if they pull out a part that is unaffected, then the other side could have a problem. i would definitely not consider your situation needing one at all since there can be a lot of complications with it.

      your liver enzymes are barely above the norm so i don’t think it’s a cause for concern. my doc told me they start to worry when liver enzymes are 3 times higher than what they should be.

      • Angela March 26, 2013 at 6:26 pm #

        Agree with Joanna on your levels not being that high and she has a good point with some complications possibly from UC. Poor vitamin levels could affect your liver which UC can definitely cause. Biopsies have come a long way, its only an outpatient procedure nowadays! When I had mine (in a pediatric hospital) they only gave me “laughing gas” and a local anesthetic. I actually remember chatting with my doc about what certain things were on the ultrasound he was using to guide the needle.

        Joanna, your liver spikes sound like they were drug related if they went back to normal when you stopped. Sounds like increased stress on your liver from all the meds (since it processes all of that!)

        • joanna March 26, 2013 at 7:41 pm #

          angela, I didn’t know the biopsy could be done with laughing gas!! could you feel it? i’d wanna be dead asleep for that.

          the doctor actually found high liver enzymes when I was diagnosed, so I’m not sure how long they were like that. i hadn’t been on any meds before and never got bloodwork. they got worse when I went on 6mp and I eventually had to stop it from that drug. it seems they have leveled off to normal levels again since I have changed my diet.

      • Raghavan October 20, 2013 at 8:06 am #

        I just came across this forum and found it very encouraging and informative. Joanna, is it ok for mr to know ow high your ALP numbers were….my daughter has it at 620 at this time…she is 23, complete outlier for PSC since we are Asian, but wo knows…..look forward to hearing back.

        Raghavan

  4. Megan March 26, 2013 at 12:35 pm #

    Hi there,
    My boyfriend has recently been diagnosed with UC but has been ill for well over a year and a half with his diagnosis being definite for only a month. He started out in hospital with severe abdominal pain, with ALP and ATP levels through the roof! It was initially thought to be an allergic reaction to antihistamines,he had endoscopys, colonoscopys, all scans, a biopsy, nothing showing any reason for such a distressed liver. His pain continued, but his liver levels started to normalise after a year. Then he started to have the more typical symptoms of UC, which has only just been confirmed.

    They never did understand the reasons for the liver levels.
    Primary Sclerosing Cholangitis was discussed, but after many many scans was found not be the root cause.

    And with regards to Angela’s comment, he doesn’t have hepatitis, which deepends the mystery further!

    • Angela March 26, 2013 at 6:09 pm #

      Did they check for regular hepatitis or Autoimmune Hepatitis? AH isn’t caused by a virus (like Hep A, B, or C) and isn’t typically checked for. The blood work for AH is very specific (which is why they don’t usually test for it). They check for ANA (antinuclear antibodies) and ASMA (anti-smooth muscle antibody) which normal people don’t produce.

      AH is much rarer in men for some reason, so it’s probably a slim chance but given it’s association with UC it always worth considering if his liver has problems again! What meds if any did they put him on for the liver?

  5. Angela March 27, 2013 at 4:18 am #

    All you felt was some pressure and a pop when they did it because of the local. The laughing gas is to calm you down so you don’t move.And I felt the same way initially throwing a fit when they were wheeling me in! But the the whole staff was very great at putting me at ease.It is ironic though that I always get general anesthesia for my colonoscopies instead (love being completely out for those haha).

    6-mp is really rough drug, it did put my AH into remission but not before I had a toxic blood reaction. So I’m glad you had a decent doc that was smart enough to have you taken off it and that diet helped! :) Our poor livers…they just get stressed by UC and then the drugs….vicious cycle!

  6. Mike H March 27, 2013 at 5:07 am #

    Hey thanks everyone for your replies. I was under the impression that my enzyme levels were pretty high, but your comments seem to suggest otherwise, which is reassuring! I’ve found it really hard to discover what normal enzyme levels are, and also what effect drugs like Pentasa and Mesalazine in general can do to them.

    It does seem like there could be many other explanations for raised liver enzymes – I feel like the specialist I saw just dropped PSC into the conversation then didn’t really give any evidence or reassurance afterwards, which left me taken aback and more stressed about what could be going on. I do know that my Dad has generally raised liver enzymes, but no UC or known problems with his liver, so there could always be a genetic side to this too. I would also have expected a clearer result from my MRCP than signs that were “consistent with inflammation” unless it’s just the early stages of PSC. It definitely sounds worth getting checked for AH too, thanks Angela,

  7. Megan March 27, 2013 at 10:27 am #

    PSC was mentioned, but mainly by us. I think UC can be a part of PSC. I share your worry!

    The only meds he was given was based on natural ingredients aimed at keeping the bile duct open and clear, but the liver leves returned to normal. I’m pretty sure he had every blood test under the sun whilst he was in hospital as he was quite poorly for quite some time, and as a heamophilliac he does get tested for Hepatitis quite regularly.

  8. Mike H April 3, 2013 at 2:32 am #

    Thanks everyone for your comments. I’m due another blood test in a couple of weeks so will see how the enzymes are doing then.

  9. MJH
    jeanne July 4, 2013 at 12:31 pm #

    Hello Mike,
    Well Just like Angela here my UC might be damage caused by the Auto-Immune Hepatitis to my colon resulting in UC. thought they cant be sure at a 100% it is what they believe a possibilitie. Although my ALT was in the 900 u/l my ALP in the 700 u/l and Gamma GT in the 400 u/l it is now slightly above the norm with medication for 3 years and considering stopping altogether after my next blood test if results are good. I had to undergo 9 different endoscopic procedures before they decided to do a liver biopsy which gave them a final answer of auto-immmune Hep. Although my specialist often refer to it as auto-immune cholengitis.
    I wish you good luck!

  10. Be Positive October 15, 2013 at 6:05 am #

    My friend is 23 and she was diagnosed with UC 3 months back and the liver enzymes for the past 2 times – ALT and AST are closer to the high end but ALP – alkaline phosphatase is closer to 625. The doctor is already hinting Primary Sclerosing Cholangitis – ultrasound of liver normal; otherwise she is generally healthy; taking UC meds everyday; no prednisone; doctor wants a biopsy done.

    Those with UC – did anyone have ALP levels as high as 625 and given a diagnosis of PSC?

    • MJH
      Jeanne October 21, 2013 at 12:31 pm #

      Hello, Reading your post I believe your friend might have the same condition that I have. I was first diagnosed with UC first then soon after I was diagnosed with Auto-Immune Hepatitis (also refered to as Auto-Immune Cholangitis). I also have high level ALP although mine were past 900. I was prescribed URSODIOL (500ml 2X a day) It is now under control in the sens that I am slightly above the norm (average 148iu I am in the 160 to 180) I do blood work every 3 months to monitor it. Liver biopsy is the only way to diagnose either disease. PSC is usualy diagnosed on heavy alcohol abuse while auto-immune hepatitis has the same symptoms but the AMA are on the positive side rather than negative. It is a disease often associated with UC. But it is not clear if one cause the other or vice versa.

      Read: http://www.ncbi.nlm.nih.gov/pubmed/15560034

  11. Raghavan October 20, 2013 at 10:29 am #

    Great web site, I have found it extremely informative and encouraging. High ALP levels with UC – around 600 – does that automatically mean PSC or is it possible that the meds for UC cause the high counts….any feedback would be super helpful.

  12. MJH
    Jeanne October 21, 2013 at 12:47 pm #

    Hello Raghavan,

    Heres some good explanation:: http://www.ncbi.nlm.nih.gov/pubmed/15560034

    To help you make the difference between PSC and Auto-Immune Hep. I read that high liver enzyme are quite common with UC but not off the chart readings… Only a liver Biopsy can diagnose either diseases. I was first diagnosed with UC then Auto-Immune Hep.

    Good luck to your daughter.

  13. Dan August 4, 2015 at 7:07 pm #

    I have have been diagnosed with mild UC then IBD for many years. I had sulfasalazine for a while but really my case is very mild and colonoscopy does reveal some inflammation but basically I use no medication and don’t watch my diet. But I also have elevated enzymes frequently. So far, my doctor did not link them, but I will mention this site. Since the last comment was almost 2 years old, maybe no one will read this, but I have used hearburn medication (Zantac – Rantidine) and recented noted that for some people Rantidine can induce liver damage. I wonder if IBD is linked to sensitivity of Rantidine – have any of you used this acid reflux medicine?

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