Interpretation of liver chemistry tests

Liver chemistry tests are frequently used to assess patients with symptomatic and asymptomatic liver diseases. However, these tests are neither sensitive nor specific and should, therefore, be interpreted in conjunction with clinical data and other laboratory investigations as well as imaging studies. Nonetheless, certain patterns in liver tests may be helpful in short listing the differential diagnosis of liver dysfunction. This article discusses the utility and limitations of liver tests in establishing the diagnosis and prognosis in patients with various liver disorders. The paper also addresses non-hepatic causes of abnormal liver chemistry tests

Dyspepsia and helicobacter pylori infection: analysis of 200 Kuwaiti patients referred for endoscopy

Dyspepsia is a very common symptom, and is the reason for most referrals for esophagogastroduodenoscopy [EGD]. Peptic ulcer disease [PUD], gastroesophageal reflux and gastric cancer account for a minority of such patients. However, the majority have no significant endoscopic abnormalities [non-ulcer dyspepsia]. Recently, infection with Helicobacter pylori [HP] has been implicated in the pathogenesis of PUD and gastric cancer. Since HP can be diagnosed by noninvasive techniques, it has been suggested that endoscopy should be restricted to HP-positive patients who do not respond to empirical therapy with antimicrobials. The aim of this study was to establish the prevalence of HP among Kuwaiti dyspeptic patients referred for endoscopy and to determine whether demographic and clinical screening, or the presence of HP, can help distinguish groups of patients with significant gastroduodenal pathology from those with non-ulcer dyspepsia. Two hundred randomly selected Kuwaiti patients referred for endoscopy were evaluated prospectively. A detailed personal interview was conducted to establish the demographic and clinical profile of each patient and a diagnostic EGD was performed after the interview. Finally, antral mucosal biopsies were taken to determine the presence of HP. The pre-coded data were analyzed. Results: The main endoscopic findings were normal [32%], non-erosive antral gastritis [26%], duodenitis [17.5%], duodenal ulcer [11.5%], deformed bulb [4%], esophagitis [7%], and erosive gastritis [2%]. The demographic and clinical characteristics of patients did not correlate with endoscopic findings. The overall prevalence of HP infection was 88.5%. There were no statistically significant differences in the prevalence of HP among patients with various endoscopic findings. HP infection is common in Kuwaiti dyspeptic patients referred for endoscopy, irrespective of their demographic and clinical features or the underlying cause of dyspepsia. Noninvasive methods to detect HP are not valid alternatives to endoscopy in the work-up of dyspeptic patients