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Persistent hypertransaminasemia in asymptomatic children: a stepwise approach.
Pietro Vajro1, Sergio Maddaluno, Claudio Veropalumbo
1Department of Medicine and Surgery, Pediatrics, University of Salerno, 84081 Baronissi, Italy. pvajro@unisa.it
World Journal of Gastroenterology
|May 21, 2013
Summary
Diagnosing asymptomatic chronic hypertransaminasemia in children requires a specific approach. A retesting panel including gamma-glutamyl transpeptidase and creatine kinase helps identify causes and guide further steps for preventing liver damage.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Clinical Diagnostics
Background:
- Isolated chronic hypertransaminasemia is frequently encountered in asymptomatic children.
- Limited comprehensive studies exist for pediatric diagnostic approaches compared to adults.
- Accurate diagnosis is crucial for preventing long-term hepatic complications.
Purpose of the Study:
- To investigate the primary causes of isolated chronic hypertransaminasemia in asymptomatic children.
- To develop a detailed diagnostic flow diagram for pediatric cases.
- To establish effective diagnostic strategies for persistent liver enzyme abnormalities in children.
Main Methods:
- A comprehensive MEDLINE literature search was conducted up to August 2012.
- Analysis of existing publications to identify common and pediatric-specific causes of hypertransaminasemia.
- Development of a diagnostic algorithm based on available evidence and clinical experience.
Main Results:
- A "retesting panel" including gamma-glutamyl transpeptidase and creatine kinase alongside aminotransferases is recommended.
- This panel aids in confirming persistent abnormalities, excluding cholestatic liver disease and myopathies.
- A multi-step diagnostic algorithm is proposed, incorporating numerous pediatric-specific scenarios.
Conclusions:
- Diagnosing asymptomatic persistent hypertransaminasemia in children presents unique challenges.
- A structured diagnostic approach is essential for timely intervention and management.
- Early and accurate diagnosis is critical to prevent progressive liver disease and ensure favorable long-term outcomes in pediatric patients.
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