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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
PubMed

Insights

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.

Keywords:
AminotransferaseChildrenHypertransaminasemiaLiver diseaseTransaminase

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