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Dr Basu
Dr Basu, Experienced Specialist
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Experience:  MD
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My liver enzymes were elevated to Ast 98 and Alt 106. I have

Customer Question

My liver enzymes were elevated to Ast 98 and Alt 106. I have been bloated. Also have had acid reflux and coughing so hard I throw up.
Submitted: 9 months ago.
Category: Medical
Expert:  Dr Basu replied 9 months ago.

Hi there,
This is Dr Basu, experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

Elevated liver enzymes and bloating can be due to the gallbladder problem.

Gallstones can cause obstruction to bile flow and can result in bloating from indigestion.

You need to get an ultrasound of the abdomen.

Inflammatory bowel disorders like Crohn's disease, microscopic colitis, eosinophilic gastroenteritis are other possibilities.
This requires colonoscopy to establish the diagnosis.
Malabsorption syndrome is another strong possibility.
Malabsorption syndrome includes the follow possibilities:
1. Excess bacterial overgrowth in the small intestine known as SIBO syndrome.
This is not usually diagnosed by the colonoscopy.
Small intestinal aspirate can be sent for bacterial count.
Carbohydrate breath test (D xylose) is a simple test to diagnose this condition.
But, the treatment is much easier.
A 14 day course of Rifaximine improves the symptoms dramatically.
2. Lactose intolerance--- regular milk, dairy products.
3.Gluten sensitivity or celiac disease--- Wheat based products.
4. Chronic pancreatitis --- deficiency of the digestive enzymes produced by the pancreas.
5. Gastroparesis -- delayed gastric and intestinal movement.-- treated with metoclopramide or domperidone daily.
You should consider following low fermentable sugar diet ( FODMAP diet) to reduce your symptoms.
Please go to this link for detailed information:
http://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf

Please also include prebiotics like Inulin daily to keep your colon acidic which prevent gas producing bacteria.
Also take a probiotic ( lactobacilli, bifidobacterium) daily to restore intestinal microbial balance.
Culturelle 30 Counts twice daily should be fine.
Simethicone and activated charcoal can be taken before meals to reduce gas and bloating.
Best wishes,
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Expert:  Dr. Thomas, MD replied 9 months ago.

Hello

Gallbladder problems typically would also raise GGT

Your symptoms indicate the need for further testing

Hepatitis must be ruled out, which can be chronic, in this respect you need

Hep B and C screens

ANA to rule out autoimmune hepatitis

Iron studies and ferritin to rule out hemachromatosis.

Liver enzymes are not a common elevation in most bowel problems, certainly not in small bowel overgrowth and malabsorption.

You need to see a gastroenterologist or liver specialist.

Reflux of this severitay can indicate ulcer, esophagitis, bile reflux, and so on.

Or, if you have not, a board certified internist such as myself.

I am a double board certified US doctor.

Find me anytime.

Please click a positive rating.

Expert:  Dr. Thomas, MD replied 9 months ago.

Hello

The system will not let me edit my post.

To raise ALT and AST from common bile duct obstruction, you would be in pain, right quadrant, you might have pancreatitis, and GGT as well as bilirubin, and white count, would typically be elevated.

See this write up:

http://emedicine.medscape.com/article/171886-workup#c7

In addition, given your symptoms, I would not wait for evaluation, but go to the ER at this point.

Vomiting can indicate small bowel obstruction in some cases.

OK, so that is an initial answer….

Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Expert:  Dr Basu replied 9 months ago.

Hi there,
This is Dr Basu, experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.

Your liver enzymes and symptoms togethe point to gallbladder problem.

Other problems like pancreatitis, malabsorption syndrome and intestinal inflammation need to be considered as well.

First you need an abdominal ultrasound and then endoscopies.

Do you have any follow up question?
Best wishes,
It was my pleasure to help you today.
If I have answered all your questions, Please rate my response Excellent (click on the 5th star).
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