Transaminitis, or hypertransaminasemia, refers to unusually high levels of a family of enzymes called transaminases. Transaminitis is not a disease, but it can point to other issues that require treatment. High levels of fat or similar problems may be causing inflammation in the liver.

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

Some causes of elevated transaminases are mild. However, transaminitis can sometimes indicate serious conditions. It is important to explore why the levels are high and diagnose any underlying issues.

The American Academy of Family Physicians (AAFP) notes that high transaminase levels are present in 10% of the population in the United States.

This article covers the causes and treatments of transaminitis. It also looks at the potential symptoms and how to prevent it.

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According to the AAFP, the most common causes of transaminitis are non-alcohol-related and alcohol-related liver disease.

Non-alcohol-related fatty liver disease (NAFLD)

This condition develops when there is too much fat in the liver cells.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 24% of adults in the U.S. may have it.

The 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 affects the liver’s function.

Learn more about NAFLD.

Treatment

There are no medications to treat NAFLD.

The following strategies can prevent or help combat fatty non-alcohol-related liver disease:

  • eating a nutritious, balanced diet
  • exercising regularly
  • maintaining a moderate weight

Alcohol-related liver disease

Excessive alcohol intake can lead to alcoholic liver disease.

In the early stages, there are typically no symptoms.

However, in the later stages, possible symptoms include:

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

The treatment for alcohol-related liver disease involves abstaining from alcohol and making lifestyle changes similar to those that doctors recommend for people with non-alcohol-related fatty liver disease.

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

Learn more about the treatment for alcohol-related liver disease.

Other causes include:

Viral hepatitis

According to the Centers for Disease Control and Prevention (CDC), hepatitis refers to a type of liver inflammation. It commonly occurs as a result of a viral infection, usually hepatitis A, B, or C.

The AAFP notes that the common causes of elevated transaminase levels are hepatitis B and C.

The following are symptoms of viral hepatitis:

Viral hepatitis can last for a few weeks or develop into serious lifelong conditions.

Only about 6–10% of adults and older children with hepatitis B develop a chronic condition. However, hepatitis C becomes chronic in most people with the infection.

Learn more

Learn more here:

Treatment

The treatment for short-term hepatitis infection involves:

  • resting
  • staying hydrated
  • managing symptoms

Healthcare professionals will monitor chronic infections and treat them with antiviral medications. Untreated viral hepatitis can cause early, permanent liver damage.

Hemochromatosis

This condition causes too much iron to build up in the body. The body stores the excess iron in organs such as the liver, heart, and pancreas, where it can contribute to health problems, including liver disease and diabetes.

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

People with this disorder tend to start experiencing symptoms aged 40–60 years. The symptoms include:

Treatment

The 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 affect the health of the liver because it processes these products.

Scientists have confirmed that several medications cause transaminitis. These drugs include:

TypeMedication
Antihypertensivelisinopril
losartan
Antimicrobialciprofloxacin
• isoniazid
• ketoconazole
• pyrazinamide
• rifampin
• tetracyclines
Chemotherapeuticsmethotrexate
• imatinib
Pain relieversallopurinol
aspirin
acetaminophen
nonsteroidal anti-inflammatory drugs
Psychiaticvalproic acid
• selective serotonin reuptake inhibitors
bupropion
• trazodone
Other baclofen
omeprazole
• amiodarone
• acarbose
• highly active antiretroviral therapy therapy

Q:

Which herbal and dietary supplements can cause transaminitis?

Anonymous

A:

Some of the more frequent offenders are found in Chinese teas or herbal products, such as kava, Jin Bu Han, chaparral, and pennyroyal. However, the list of herbal medications and supplements associated with transaminitis is quite long. The National Institutes of Health (NIH) created an extensive searchable database where you can look up any dietary or herbal supplement to check its safety before use.

Emelia “Mimi” Arquilla, DOAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Treatment

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 the drugs are not interfering with the liver or its enzyme levels.

Rarely, the following conditions, among others, can lead to transaminitis:

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

Alpha-1 antitrypsin deficiency

This genetic disorder damages the liver and lungs. The degree of damage can vary from raised levels of transaminases to liver failure.

Approximately 15% of adults with this disorder develop scarring of the liver. They also have a higher risk of developing a form of liver cancer called hepatocellular carcinoma.

Symptoms associated with alpha-1 antitrypsin deficiency include:

  • a swollen abdomen
  • swollen feet or legs
  • jaundice of the skin and eyes

This disorder also causes lung-related symptoms, which typically appear between the ages of 25 and 50 years. They include shortness of breath, wheezing, a rapid heartbeat, and fatigue.

Learn more about alpha-1 antitrypsin deficiency.

Treatment

A healthcare professional can diagnose an alpha-1 antitrypsin deficiency with a blood test or genetic testing. There is no cure, so the aim of treatment is to manage the symptoms.

Autoimmune hepatitis

This condition occurs when the immune system attacks the liver’s cells, but experts do not fully understand what causes it. It affects 11–17 people per 100,000.

The symptoms of autoimmune hepatitis include:

  • abdominal pain
  • an enlarged liver
  • fatigue
  • jaundice
  • joint pain
  • a loss of menstruation
  • rashes
  • the appearance of small blood vessels on the skin

Without treatment, autoimmune hepatitis can cause scarring of the liver, and it can eventually lead to liver failure.

Learn more about autoimmune hepatitis.

Treatment

The treatment options include immune-suppressing medications and a liver transplant.

Learn more about autoimmune hepatitis treatments and their side effects.

Wilson’s disease

This rare inherited disorder causes copper to collect in organs such as the liver and brain. The disease can be life threatening if the levels of copper become too high.

Symptoms include:

  • abdominal pain
  • coordination problems
  • copper coloring around the eyes, known as Kayser-Fleischer rings
  • difficulty speaking or swallowing
  • fatigue
  • jaundice
  • a loss of appetite
  • stiff muscles
  • swelling in the legs or abdomen
  • uncontrolled movements

A healthcare professional can diagnose Wilson’s disease using:

  • blood tests
  • genetic tests
  • a liver biopsy

Learn more about Wilson’s disease and how to treat it.

Treatment

People can manage the condition with medications that remove excess amounts of copper and prevent further buildups.

Other medical conditions

Several conditions that seem unrelated to the liver can cause transaminitis. Often, there are no liver-related symptoms.

These conditions include:

  • thyroid disorders, such as hypothyroidism and hyperthyroidism
  • celiac disease, in which the immune system reacts to gluten
  • hemolysis, which is the rupturing of red blood cells
  • muscle disorders, such as rhabdomyolysis and polymyositis

The AAFP notes that mild cases of transaminitis are often asymptomatic, meaning that no symptoms are present. However, the underlying condition affecting the liver can cause symptoms.

A person should contact a doctor if they experience any of the symptoms mentioned in this article.

To diagnose transaminitis, a doctor will take a full medical history and perform a physical examination. They may also order blood tests, for which they will ask the person to fast beforehand.

The blood tests will determine the total iron-binding capacity of the blood, as well as the levels of:

  • glucose
  • iron
  • ferritin
  • hepatitis B surface antigen
  • hepatitis C virus antibody

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

A person can prevent transaminitis by taking certain steps. These include:

  • eating a balanced diet
  • engaging in moderate physical activity on a regular basis
  • maintaining a moderate weight
  • seeking prompt treatment for viral infections
  • controlling chronic conditions, such as diabetes or autoimmune hepatitis, by following a prescribed treatment plan
  • taking the recommended dosages of supplements and medicines
  • discussing alternative options, if medications are causing the elevated levels of transaminases
  • protecting themselves from hepatitis A and B with a vaccine

An increase in liver enzymes can sometimes indicate a serious underlying health condition.

A person’s outlook will depend 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 the levels of transaminases and prevent further damage to the liver.

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