Table of Contents
ISRN Hepatology
Volume 2013, Article ID 256426, 6 pages
Review Article

Mild Hypertransaminasemia in Primary Care

1Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University, P.O. Box 35, 123 Muscat, Oman
2Department of Gastroenterology, Jewish General Hospital, McGill University, Montreal, QC, Canada H3T 1E2

Received 5 February 2013; Accepted 12 March 2013

Academic Editors: C. S. Hsu, D. G. Kim, and C. Kordes

Copyright © 2013 Said A. Al-Busafi and Nir Hilzenrat. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The liver enzymes, alanine transaminase (ALT) or aspartate transaminase (AST), are commonly used in clinical practice as screening as well as diagnostic tests for liver diseases. ALT is more specific for liver injury than AST and has been shown to be a good predictor of liver related and all-cause mortality. Asymptomatic mild hypertransaminasemia (i.e., less than five times normal) is a common finding in primary care and this could be attributed to serious underlying condition or has transient and benign cause. Unfortunately, there are no good literatures available on the cost-effectiveness of evaluating patients with asymptomatic mild hypertransaminasemia. However, if the history and physical examination do not suggest a clear cause, a stepwise approach should be initiated based on pretest probability of the underlying liver disease. Nonalcoholic fatty liver disease is becoming the most common cause of mild hypertransaminasemia worldwide. Other causes include alcohol abuse, medications, and hepatitis B and C. Less common causes include hemochromatosis, α1-antitrypsin deficiency, autoimmune hepatitis, and Wilson's disease. Nonhepatic causes such as celiac disease, thyroid, and muscle disorders should be considered in the differential diagnosis. Referral to a specialist and a possible liver biopsy should be considered if persistent hypertransaminasemia for six months or more of unclear etiology.