Increased SGOT and/or SGPT levels along with fatty liver (NAFLD and NASH)

Mildly increased levels of SGOT and SGPT are seen many times in patients who are otherwise healthy and have no symptoms.

If sonography is done, 'fatty liver' is also usually found. If the patient does not consume alcohol, or if consuming but within safe limits only, the the diagnosis of Non-Alcoholic Fatty Liver Disease(NAFLD) is considered. If such 'fatty liver' patient has increased levels of SGOT and/or SGPT, the diagnosis is stepped-up to Non-alcoholic Steato-Hepatitis(NASH).

NASH is an inflammatory disease process - which means liver cells are being damaged(and also being repaired simultaneously). Most of the time, the damage is fully repaired. But in some cases, the damaged may not be repairable and those liver cells will be 'deleted' and replaced with scar tissue(fibrous tissue). Such condition where irrepairable liver cells have been deleted and replaced with fibrous tissue is called as 'liver fibrosis' or 'liver cirrhosis'. Liver cirrhosis is more commonly as "holes in liver due to excessive drinking of alcohol (Jyada daaru peekar liver mein chhed ho gaye hain)" by dialogues in Hindi movies. Liver cirrhosis will ultimately progress to liver failure. But that does not mean that every patient with mild increase in SGOT and SGPT levels will develop liver cirrhosis and then liver failure. Read the statistics below.

Fortunately, not all 'fatty liver' patients have NASH, and not all NASH patients worsen to liver cirrhosis. About 20 to 30% of fatty liver patients will worsen to NASH. Around 5 to 12% of NASH patients will worsen to liver cirrhosis.

However, before being sure that its NASH, patients must check with their doctor that other common causes mild hepatitis have been ruled out. Especially one resulting from chronic low-grade viral infections of liver(Hepatitis B and C, cytomegalovirus, etc.). It will be prudent for the patient to ask his doctor to check him for markers of chronic viral hepatitis(it is a set of blood tests).

Patients should be aware that relying on LFT(liver function tests) done on blood sample can be misleading. Normal levels of SGOT/SGPT do not guarantee that damage done to liver cells has healed perfectly. While the treatment(medicine, diet change, exercise) taken by patient may lower the raised SGOT/SGPT levels to normal levels, by itself, it is no guarantee that the liver cells have healed and not fibrosed(deleted and replaced with scar tissue). A patient who wants to be sure that liver has healed(and not fibrosed) must do 'liver elastography' - which is similar to sonography. If necessary, liver biopsy may also be done. However, liver biopsy is not a trivial investigation(its like a surgery) and hence must be opted only when benefits may be higher than the risk.

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