Persistent hypertransaminasemia in asymptomatic children: A stepwise approach.

We aimed to examine the major causes of isolated chronic hypertransaminasemia in asymptomatic children and develop a comprehensive diagnostic flow diagram. A MEDLINE search inclusive of publications throughout August 2012 was performed. We found only a small number of publications that had comprehensively investigated this topic. Consequently, it was difficult to construct a diagnostic flowchart similar to those already available for adults. In children, a "retesting panel" prescription, including gamma-glutamyl transpeptidase and creatine kinase in addition to aminotransferases, is considered a reasonable approach for proficiently confirming the persistence of the abnormality, ruling out cholestatic hepatopathies and myopathies, and guiding the subsequent diagnostic steps. If re-evaluation of physical and historical findings suggests specific etiologies, then these should be evaluated in the initial enzyme retesting panel. A simple multi-step diagnostic algorithm incorporating a large number of possible pediatric scenarios, in addition to the few common to adults, is available. Accurately classifying a child with asymptomatic persistent hypertransaminasemia may be a difficult task, but the results are critical for preventing the progression of an underlying, possibly occult, condition later in childhood or during transition. Given the high benefit/cost ratio of preventing hepatic deterioration, no effort should be spared in diagnosing and properly treating each case of persistent hypertransaminasemia in pediatric patients

Treatment of children with chronic viral hepatitis: what is available and what is in store.

At present, therapy of children with chronic hepatitis B and C is still based on few drugs, all burdened by a series of side-effects, unsatisfactory serum conversion rates, and/or drug-resistance. Moreover, selection of subjects to treat with conventional therapies is not univocal, especially during the pediatric age when the disease course is often mild with significant spontaneous seroconversion rate. Our review deals with pros and cons points when a physician decides to design a drug therapy for a child with chronic viral hepatitis, and different possible therapeutic opportunities. METHODS: A literature search was performed through PubMed. The newest articles, reviews, systematic reviews, and guidelines were included in this review. RESULTS: The management of children with viral hepatitis is still controversial over whom and when to treat and the use of drug(s). Novel therapeutic strategies have been evaluated only in clinical and preclinical trials involving, for instance, "therapeutic" vaccines. The data on safety and effectiveness of new drugs are also reviewed. CONCLUSION: The results of reported studies confirmed that at least some of the new drugs, with greater efficacy and/or minor side-effects, will be used clinically

Hypertransaminasemia: Is it Always Liver Disease? The Case of Subclinical Myopathies and Macroenzymes

Abstract: Aminotransferases increase in serum is generally considered indicative of liver cell injury. However, these enzymes are also present in tissues other than the liver, mainly the muscles. Therefore, after an incidental finding of hypertransaminasemia, serum creatine kinase check and an accurate physical examination -looking for subtle signs of muscular affection- are necessary to reach a correct diagnosis and avoid missing salient signs of a muscular disorder.In the case of protracted isolated AST elevation, the possibility of macro-AST should be taken into account as well. This is a generally benign condition, whose prompt recognition might avoid expensive, and occasionally invasive liver disease-related diagnostic procedures. Polyethylene glycol testing is considered a valuable screening test