When a person has elevated liver enzymes, both patient and doctor want to find out what’s causing them. And thanks to modern technology, it’s easier than ever to run a battery of blood tests at once. All the doctor has to do is check a box ordering a panel of tests, the patient gives blood samples once, and they wait to find out the possible causes of the liver problem. Sounds simple, right?
It is. But researchers at the University of Michigan who have published papers on the topic in both the Journal of Hospital Medicine and the Journal of Hepatology are suggesting that simple isn’t always better. That’s because many of these panels screen for rare conditions that aren’t causing the problem in most patients.
Initially, that might not sound like a big deal. After all, these conditions are rare, so what does testing for them hurt? There are actually a number of problems with this approach. The first is that many of these tests easily yield false positives. This can be very stressful for the patient, who is now told to undergo a liver biopsy while facing fear about managing a difficult condition and the possibility of having passed it on to loved ones, if it’s genetic.
Next is the cost of these tests. While a panel might not cost much on an individual patient level, even small costs add up over time. In fact, the researchers point out that conducting these blood tests on every hospitalized patient would cost $40 million a year. And, of course, those costs skyrocket if waiting on the test results prolongs a hospital stay – or if they have to perform unnecessary biopsies.
Finally, the researchers point out that most rare liver diseases don’t cause acute liver damage. So waiting two weeks to rule out more common liver issues is unlikely to affect the course of the disease or the treatment options available, or cause further harm to the patient.
The researchers recommend that doctors first focus on common causes of liver problems, such as lifestyle factors such as alcohol consumption, drug use and viral infections, including hepatitis B and C. Doctors also should ask questions about prescription drugs known to cause liver damage. If there’s an obvious culprit, doctors should focus on that as the most likely reason for elevated liver enzymes, rather than testing for much more unlikely conditions. It might be inconvenient for a patient to have blood sampled more than once, but it’s a lot better than having an unneeded biopsy.
Of course, the best way to avoid having unnecessary liver tests is to protect your liver. Maintaining a healthy weight, limiting your alcohol consumption and eschewing drug use are obvious first steps. But you can also protect your liver by keeping toxins out of your body. Your liver performs over 500 essential functions for your body, including helping with detoxification. So lightening your toxin load can help you avoid overtaxing your liver. Choose raw organic foods as much as possible and avoid pesticides and environmental toxins.