Colitis ulcerosa e isotretinoína, ¿existe una relación causal? / Ulcerative colitis and isotretinoin: is there a causal relationship?

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Elevación de las enzimas de función hepática en nuestro medio: estudio etiológico y de la eficacia de una consulta de acto único / Liver enzymes elevation: etyologic study and efficiency of a single-act office visit

Introducción La elevación de las enzimas de función hepática (EFH) constituye un hallazgo frecuente en los análisis de rutina de la población general. Existen pocos datos de las enfermedades más prevalentes causantes de estas alteraciones en nuestro medio. Además, su estudio conlleva el descarte de múltiples etiologías siendo necesario realizar varios exámenes y visitas al especialista. Nos planteamos evaluar las causas más frecuentes de la elevación de EFH en una consulta de acto único (CAU). Métodos Desde marzo de 2008 a junio de 2010 se derivaron desde su centro de salud los pacientes que incidentalmente presentaron elevación de las EFH (elevación de transaminasas, elevación conjunta de fosfatasa alcalina [FA] con gamma-glutamil transpeptidasa [GGT] y elevación aislada de GGT). A estos pacientes se les realizó nuevamente una analítica que incluía las EFH, serología viral, autoanticuerpos, ceruloplasmina, metabolismo del hierro, alfa-1-antitripsina y hormonas tiroideas. Los resultados fueron valorados por un hepatólogo, junto a una ecografía que se realizaba el mismo día. Resultados Se incluyeron 427 pacientes. La elevación de las transaminasas se relacionó al hígado graso no alcohólico (HGNA) (40%), alcohol (17%) y VHC (13%). La elevación de GGT fue por HGNA (30%), alcohol (27%) y hepatotoxicidad (8%) y la elevación de GGT y FA por el HGNA (21%), alcohol (17%) y hepatotoxicidad (11%). La elevación autolimitada se vio en el 9%, mientras que en un 11% no pudo identificarse causa. Se llegó al diagnóstico definitivo en el 79% de los casos. Conclusiones La CAU permitió el diagnóstico en la gran mayoría de los casos. El HGNA es la causa más frecuente de elevación de las EFH en nuestro medio, elevación que debería ser confirmada antes de realizar un estudio etiológico(AU)

Background Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit. Methods From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist. Results A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients. Conclusions The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started (AU)

[Liver enzymes elevation: etiologic study and efficiency of a single-act office visit]. / Elevación de las enzimas de función hepática en nuestro medio: estudio etiológico y de la eficacia de una consulta de acto único.

BACKGROUND: Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit. METHODS: From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist. RESULTS: A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients. CONCLUSIONS: The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started.