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World J Gastroenterol. May 14, 2013; 19(18): 2740-2751
Published online May 14, 2013. doi: 10.3748/wjg.v19.i18.2740
Persistent hypertransaminasemia in asymptomatic children: A stepwise approach
Pietro Vajro, Sergio Maddaluno, Claudio Veropalumbo
Pietro Vajro, Department of Medicine and Surgery, Pediatrics, University of Salerno, 84081 Baronissi, Italy
Pietro Vajro, European Laboratory for Food Induced Disease, 84081 Baronissi, Italy
Sergio Maddaluno, Claudio Veropalumbo, Department of Translational Medical Sciences, Pediatrics, Medical School of the University of Naples “Federico II”, 80131 Naples, Italy
Author contributions: Vajro P, Maddaluno S and Veropalumbo C contributed equally to this work.
Correspondence to: Pietro Vajro, Professor, Department of Medicine and Surgery, Pediatrics, University of Salerno, Via Allende, 84081 Baronissi, Italy.
Telephone: +39-89-965016  Fax: +39-89-672409
Received: November 12, 2012
Revised: December 20, 2012
Accepted: January 17, 2013
Published online: May 14, 2013

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.

Keywords: Transaminase, Aminotransferase, Hypertransaminasemia, Liver disease, Children