So I am on Remicade 900 mg every 6 weeks, Methotrexate 12.5 mg weekly and various antibiotics (in rotation, but 500 mg daily) since November 2015 (and on antibiotics in higher dosages since 1995 or so). My blood labs are checked quarterly and never had an issue until January 25, 2019, when my liver chemistries came back slightly elevated. My GI ordered a re-test, and my February 26, 2019 retest came back even more elevated. My GI doc is on vacation in Mexico but called and said he wants to do more tests on me to find out why the liver chemistries are suddenly elevated. He sounded concerned.

I understand that a liver biopsy and liver ultrasound are possible tests. Anyone here ever have such testing? I heard with the liver biopsy a long needle is inserted in the liver through the abdominal wall. Is sedation used for this procedure? What tests do you think he will order?

Original Post

I'm sorry you are experiencing the "joy" of elevated liver enzymes. I've got the t-shirt for that too only mine began right after my j pouch surgeries.  I've since been diagnosed with PSC (Primary sclerosing cholangitis). According to a GI doctor I had from U of M, PSC is common in people who have had Ulcerative Colitis.  Mine was confirmed from liver biopsies that were done.  I also have had quite a few ultra-sounds on the liver to make sure the bile ducts are open. Every couple of years my GI also orders a MRI to look at the liver.  

I have had two biopsies to check my liver.  I don't think the first one was sedated because I remember having to lie still and felt pressure while they took the sample.  The second one was sedated.  Following the biopsies, I had to lie still for at least an hour.  (That meant no getting up even for the bathroom.)

After I discovered my enzymes were high I started taking Milk Thistle.  I use Nature's Bounty and take 250 mg 3 times a day with meals.  Since then, I have had several lipid profiles done and my enzyme levels have been normal.

On a side note: Liver issues are nothing to take lightly.  My brother actually died of PSC at the age of 31. I'm not telling you this to scare you, but to encourage you to take it easy on things that aggravate the liver like alcohol.  Also catching it early can prevent additional damage to it.




Still Standing,

Thanks for your informative post. I definitely am not taking this lightly and intend to pursue whatever testing is ordered on me. My Doctor mentioned various tests but also said we would first meet and have an appointment to discuss them. He wants to determine what is causing the sudden elevation. Keep in mind I have been on a my current medication regimen for a while now and we just recently saw a spike so he wants to know what is causing the spike and so do I. I hope it’s not PSC, but if it is I would rather know sooner than later. 

If I may be honest I have been waiting a long time for the other shoe to drop and always believed I might one day have liver issues due to the myriad and extensive drugs I have bombarded my body with to fight IBD and have a reasonable quality of life. I have never been planning to live to be an old man and have lived my life accordingly. This may sound harsh or fatalistic, but to me it’s just living in reality and knowing what the possibilities are. 

What kind of sedation was given in your second liver biopsy? Similar to conscious sedation for a pouch scope?

I agree just the weapons used to fight IBD are enough to cause anyone havoc on the liver.   I'm also with you on the fact I'd rather know what is causing the enzyme spike now rather than later.  There is greater fear of the unknown. At least knowing what's wrong gives you a chance to fight it .  

The sedation for my biopsy was very similar to the ones given for my scopes although, I came out of it faster, so it may not have been as strong. I remember most of the wait time afterward before I could get up - so probably very mild sedation for this one. (My husband said it all went very quickly.)

Praying you get some answers soon!

I saw my Doctor today and he ordered a liver ultrasound and also told me to stop taking Methotrexate with my Remicade.  He said that since I am on Remicade for 3 plus years with no development of antibodies, then it's probably okay to go off the Methotrexate.  Despite these precautions, he think my abnormal liver chemistries are due to gaining weight, so he also ordered me to lose 10 pounds as well and get my blood labs retested in a month. He also said no alcoholic beverages until my liver chemistries normalize.

They only time my liver was an issue was due to congestive heart failure.  Initially, they thought I was abusing Tylenol (not!).  I had no idea the heart can affect the liver, but... it does.  All lab tests are good for now that I have semi-recovered from my heart failure incident.  

I had my liver ultrasound today at Yale and it was read by the radiologist and my GI as evidencing a fatty liver. The comment my GI made was that I have a very “echogenic liver”, which apparently means more dense than usual towards sound waves.

Since my liver chemistries were consistently normal for the last 3 years and I have gained weight recently, it’s kind of hard to ignore the sign that my body is telling me I need to lose weight. 

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