As is often the case with professional societies, the American College of Gastroenterology (ACG) engages its members in creating guidelines to help physicians care for their patients based on “state-of-the-art scientific work and the principles of evidence-based medicine,” according to the ACG. Its most recent guideline, whose writers were led by Paul Kwo, MD (professor, gastroenterology & hepatology), addresses the proper evaluation of abnormal liver chemistries.

There is evidence that has accumulated over the past decade that abnormal liver chemistries are associated with increased liver-related mortality worldwide. The obesity epidemic is but one reason for these abnormalities; among others are chronic viral hepatitis, alcoholic liver disease, and advanced liver disease with cirrhosis.

Kwo and his colleagues for the first time defined a normal healthy serum alanine aminotransferase (ALT) level, advising physicians to assess patients with levels higher than these new normal levels: 25IU/L and 33IU/L for women and men, respectively.  The guideline also provides a step-wise algorithm to guide the evaluation of patients with other abnormal liver tests including alkaline phosphatase and bilirubin. Steps in such an evaluation typically begin with serology and move through radiology to, when needed, liver biopsy.

An important factor underlying the need for this updated guideline is the fact that there is a substantial population of patients who have liver disease that is not yet recognized. Having a newly defined normal level of ALT will help both gastroenterologists and non-gastroenterologists more effectively identify these individuals by  routine blood tests and evaluate and/or refer them for both diagnosis as well as therapy where appropriate.

Kwo’s two coauthors of the guideline were Stanley Cohen, MD, of Case Western Reserve University and Joseph Lim, MD, of Yale University. The guideline can be accessed here: http://gi.org/wp-content/uploads/2016/12/AJG-Liver-Chemistries-Guideline-Release-12202016.pdf