Transient Hypertransaminasemia in Pediatric Patients With Crohn Disease

Abstract

To the Editor: We note with interest the article published by Schatorjé and Hoekstra (1) describing transient elevation of transaminases in 11 children with newly diagnosed Crohn disease (CD) managed with exclusive enteral nutrition (EEN) as sole therapy to induce remission. The mean levels of alanine and aspartate aminotransferases (ALT and AST) increased around 10-fold within 3 weeks of starting EEN, with subsequent normalization within 12 weeks of diagnosis. We reviewed the results of laboratory testing available for a published cohort of 12 children with newly diagnosed CD managed with 8 weeks of EEN (2). ALT and AST levels along with gamma-glutamyl transpeptidase (GGT) levels were available at diagnosis, after 2 to 3 weeks and 8 weeks of EEN as well as 1 to 2 months following EEN. Normal ranges of AST and ALT in our local laboratory were <45 and <45 U/L, respectively. At diagnosis, all of the markers were within normal ranges: mean levels of AST and ALT were 16.6 and 13.1 U/L, respectively. After 2 to 3 weeks of EEN, the average AST levels were 26.2. Subsequent means were 25 at 8 weeks and 16.8 after EEN. Average ALT levels rose initially to 21.9 U/L and were subsequently 21.2 at 8 weeks and 14.2 after EEN. ALT levels were above the upper range of normal (45 U/L) at 2 to 3 weeks in only 2 children (51 and 48, respectively) and at 8 weeks in 1 child (48 U/L). GGT levels did not change and none of the group has subsequently developed liver disease. In summary, although this retrospective data showed increasing transaminases during nutritional therapy, only a minority were above the normal range. These changes do not appear clinically significant and differ from the data provided by Schatorjé and Hoekstra (1). Further prospective investigation of transaminases during treatment of active CD will be required to establish the relevance of these observations.