Fatty liver or cirrhosis

[travelman979]

Dear Dr. Schiano,

Two years ago I was diagnosed with fatty liver by ultrasound.  Was having some gastro-intestinal symptoms, mainly abdominal bloating, discomfort and fatty stools.  The LFTs were normal.  At the time, both my internist and gastroenterologist blew it off and said, "It's simple fatty liver. Don't worry about it."  I even asked if I could continue moderate alcohol consumption, and they said yes.

Several weeks ago I returned for follow-up due to continued symptoms and -- after a good bit of internet research -- a great deal of concern that my continued alcohol use may have done damage to my liver.  I currently drink 1 or 2 units per day.  Only rarely will I drink 3 (once every six or eight weeks).  This has been my pattern for seven years, although prior to that I drank less often but heavier.  In fact, from 1987 to 2004, I drank on 30-35 days per year (4 to 8 beers) with 3-4 occasions during that time of serious intoxication (10-12 beers).  

I had LFTs in 2007, 2009 (first diagnosis of fatty liver) and 2011.  All results in normal ranges, except:  2009, AST/ALT was 19/17, and I hear that is not good; most recent LFT showed high cholesterol -- 224 and glucose -- 105.  Everything else totally normal.  Another ultrasound has confirmed fatty liver again.  I have ceased all alcohol consumption and plan to remain abstinent.  I am 50 years old and want to watch my grandchildren grow up.  I have also changed my diet and begun exercise. Not overweight.

I have developed anxiety that my previous alcohol use/abuse caused cirrhosis and that the fatty liver is, in fact, something much worse.  I am very afraid. How likely that I have cirrhosis with three normal LFT's over four years? Does the AST/ALT flip-flop in 2009 mean that I have alcoholic liver disease? I am seeing my gastroenterologist on Monday for follow-up.

Can you offer some insight, advice or help me with questions to ask?  I would be most grateful.

[Thomas D Schiano, MD]

yes..................but continue clean living.  good luck.

[travelman979]

Thank you.  Saw the doctor today before receiving your reply.  More a consultation than examination.  He expressed no concern about anything serious and recommended follow-up blood work annually. My platelet count was normal on each of the last two LFTs -- 246 (two weeks ago) and 220 (in 2009), although B-12 dropped pretty significantly in the last two years.  I did not ask about FibroSure since I had not read your response. He even said alcohol reduction was unnecessary, but I am sticking with that one.  He also suggested Vitamin E, diet and exercise (no weight reduction necessary -- 6'0" and 176 lbs. -- but 38.5" abdominal measurement).  Regarding cirrhosis, his response to my past drinking history was, "Next to impossible." Should I put this to bed, so to speak, and move on?  

[Thomas D Schiano, MD]

my gut sense is that you did not develop cirrhosis but it can be present even in the setting of normal liver tests.  if the platelet count is low it could be consistent with cirrhosis.  your doc can also check a fibrosure tests which is a non-invasive marker of fibrosis.  I agree with cutting back your alcohol intake for now.  Is weight loss also required?  there is some data to suggest also that Vitamin E 400 IU twice daily can help fatty liver.