Indian J Med Sci About us | Subscription  |  Top cited articles | Contact Us | Feedback | Login   
Print this page Email this page   Small font size Default font size Increase font size 
 Users Online : 9
Home Current Issue Ahead of print Back Issues  Instructions Search e-Alerts
  Navigate here 
  Search
 
 ¤  Next article
 ¤  Previous article 
 ¤  Table of Contents
  
 Resource links
 ¤   Similar in PUBMED
 ¤  Search Pubmed for
 ¤  Search in Google Scholar for
 ¤   [PDF Not available] *
 ¤   Citation Manager
 ¤   Access Statistics
 ¤   Reader Comments
 ¤   Email Alert *
 ¤   Add to My List *
* Registration required (free)  


  In this article
 ¤  Material and Methods
 ¤  Results
 ¤  Discussion
 ¤  Summary
 ¤  References
 ¤  Article Tables

 Article Access Statistics
    Viewed1539    
    Printed51    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 


 
ORIGINAL CONTRIBUTION
Year : 1997  |  Volume : 51  |  Issue : 8  |  Page : 270-274
 

"Significance of serum gamma glutamyl transpeptidase in cholestatic jaundice"


Department of Medicine, Indira Gandhi Medical College, Shimla-171 001., India

Correspondence Address:
Kailash Chand
Department of Medicine, Indira Gandhi Medical College, Shimla-171 001.
India
Login to access the Email id


PMID: 9491680

Get Permissions



How to cite this article:
Chand K, Thakur S. "Significance of serum gamma glutamyl transpeptidase in cholestatic jaundice". Indian J Med Sci 1997;51:270-4

How to cite this URL:
Chand K, Thakur S. "Significance of serum gamma glutamyl transpeptidase in cholestatic jaundice". Indian J Med Sci [serial online] 1997 [cited 2014 Nov 1];51:270-4. Available from: http://www.indianjmedsci.org/text.asp?1997/51/8/270/11506


The differentiation between me­chanical biliary obstruction and intrahepatic cholestasis represents one of the classcial diagnostic challenges in clinicall medicine. History, physical examination and review of routine laboratory tests are the most important initial steps in the evaluation of patient with cholestatc jaundice. [1] The earliest clinical studies demonstrated that serum gamma-glutamyl transpepti­dase (G.G.T.) is a sensitive index of hepatobiliary dysfunction. [2] In cholestatic liver disease, serum G.G.T. may rise to values averag­ing 12 times the upper reference limit. [3] While comparing serum G.G.T. determination and those of other marker enzymes of biliary stasis, such as alkaline phosphates and leucine aminopeptidase, the relative elevations of serum G.G.T. are very much greater, conferring superior sensitivity in the diagno­sis of biliary tract disorders. The values of serum G.G.T. are gene rally higher in extrahepatic ob­struction than intrahepatic choles­tasis. [4] The present study was thus directed to find out the value of serum G.G.T. estimation in evalu­tion of cholestatic jaundice.


 ¤ Material and Methods Top


The study was conducted on forty patients of hepato-biliary diseases admitted in Indira Gandhi Medical College, Shimla. They were clinically divided into four groups, each group comprising of ten patients each of acute hepatitis without cholestasis cirrhosis, intra­hepatic and extrahepatic cholesta­sis. Criteria for selection of pa­tients with cholestasis included jaundice, pruritis, light coloured stools, conjugated hyperbilirubi­naemia and raised alkaline phos­phatase (usually to more than 3 times of normal). In all patients, serum bilirubin (total and conju­gated) transaminases (SGOT, and alkaline phosphatase were measured. In cholestasis groups, real-time ultrasonography allowed distinction between extrahepatic cholestasis with dilated bileducts within the liver and intrahepatic cholestasis, where intrahepatic biliary radical dilatation was not seen. Serum G.G.T. activity was measured in all to hforty patients, employing the methods of Szasz, Rosalki and Tarlow, as described in the method of enzymatic analy­sis (1974) by using the kit of tran­sasis-Biomedicals Pvt. Ltd. Non­hepatic disorders such as acute pancreatitis, congestive cardiac failure, acute myocardial Infarction, diabetes mellitus, alcoholics and patients taking hepatic microsomal enzyme inducting drugs, where serum G.G.T. is raised, were ex­cluded from cholestasis group by appropriate history, clinical exami­nation and relevant investigation. The mean values were estimated for all biochemical parameters and statistical significance of difference between means was estimated.


 ¤ Results Top


In the present study, the mean serum G.G.T a tivities in intrahep­a:ic and extrahepatic cholestasis were found to be 75.6±28.36 lu/L and 165.6±47.02 lu/L respecti­vely. Although serum G. G. T. activities were higher in both types of cholestasis when com­pared with normal mean value (17.5 l.U/L), the rise was signifi­cantly higher in extrahepatic cholestasis as compared to intra­hepatic cholestasis (p<0.01). The mean serum G.G.T. activities in acute hepatitis and cirrhosis group were found to be 58.8±31.59 I.U/L and 78.3±71.39 lu. L, mean serum G.G.T. values being higher in both groups as compared to normal mean value (17.5 IU/L). However serum G.G.T. values were signifi­cantly higher in extrahepatic cholestasis group when compared with acute hepatits group (p<0.01) end cirrhosis group (p<0.05). In inrahepatic cholestasis group, rise in serum G.G.T was not signifi­cantly higher when compared with acute hepatitis group and cirrhosis group (p<0.05). [Table 1])

While comparing serum G.G.T. and alkaline phosphatase in extra­hepatic cholestasis group, both enzpmes showed a rise of more than 3 times the normal mean value. Both serum G.G.T. and al­kaline phosphatase were raised in 100% cases of extrahepatic obstruction. [Table 2].


 ¤ Discussion Top


Serum G.G.T. rises in cholesta­sis and mean serum G.G.T. activity are considerably higher in extra­hepatic cholestasis than intrahep­atic cholestasis. [5],[4] In the present study, rise in mean serum G.G.T. activity was significantly higher in extrahepatic cholestasis as com­pared to intrehepatic cholestasis (p<0.001). In extrahepatic chole­stasis group, biliary obstruction was caused by calculus disease in 30% cases and maligant disease in 70% cases mean serum G.G.T. activity in two groups was found to be 206±48.59 IU/L and 150.85± 42.41 IU/L respectively. The mean serum G.G.T. activity in malignant, disease and calculous disease causing extrahepatic biliary ob­struction did not show any statis­tically significant difference. In contrast, Rutenberg et al [6] found serum G.G.T. activity to be con­siderably higher in extrahepatic obstruction caused by malignant disease than in other caused of cholestasis. Highest serum G.G.T. activity was seen in a case of cholangitis, as was also reported by Szczeklik et aI. [7] In cholestatic liver disease, serum G.G.T. may rise to values averaging 12 times the upper reference limit and is more often raised than alkaline phosphatase. [3] However, in our study, serum G.G.T was not in­creased more often and to a grea­ter - extent, when compared with alkaline phosphatase, similar ob­servations being made in a study conducted by Betro et al. [8] Raised serum G.G.T activity is seen in pa­tients with acute hepatitis. [6] In cir­rhosis, serum G.G.T activity tends to be variable. Occasionally it may be very high, while at other times, serum G.G.T. may be nor­mal. [4],[9] In the present study, mean serum G.G.T activity in acute hepa­titis group and cirrhosis group was found to be 58.8+ _ 31.59 IU/L and 75.6±28.36 I.U/L respectively. In both groups, serum G.G.T. was found to be higher as compared to normal mean value (17.5.I.U./L).


 ¤ Summary Top


In conclusion, our study showed that serum G.G.T rises in cholesta­sis, and the rise is significantly higher in extraphepatic cholesta­sis as compared to intrahepatic cholestasis. Serum G.G.T has not shown any superiority over alka­line phosphatase in the evaluation of cholestatic liver disease. How­ever, two considerations must caution against the use of serum G.G.T. alone for evaluation of hepatobiliary disease. The first of these is the lack of specificity for hepatobiliary disease. Serum G.G.T. activity can be elevated in some non-hepatic disorders such as acute pancreatitis, congestive cardiac failure, myocardial infarc­tion, diabetes mellitus and alcoho­lism. Determination of serum G.G.T. in these patients is of no value. Second, the possibility that changes in serum G.G.T. activity results from drug administration in man. [10]

 
 ¤ References Top

1.Schenker S, Balint J, Schiff L. Differential diagnosis of j aundic report of a prospective study of 61 proved cases. Am J Dig. Dis 1962; 7:449-63.  Back to cited text no. 1      
2.Rosalki SB. Gamma-glutamyl trans­peptidase. In: Bodanski 0, Latner AL, eds. Advances in clinical chemistry. Vol 17 pg. 53-107. New York. Academic Press, 1975.  Back to cited text no. 2      
3.Dragosics B, Ferenci P, Pesendor­fer Fetal. Gammaglutamyl trans­peptidase: its relationship to other enzymes for the diagnosis of liver -. disease, In Popper H, Schaffner r,, eds. Progress in liver diseases. vol. 5, pp. 436-439. New York : Grune and stratton, 1976.  Back to cited text no. 3      
4.Goldberg. DM, Martin JV Role of Gamma-glutamyl transpeptidase activity in the diabbetes-melitus. Clin Chem Acta 1972;38:419-434.  Back to cited text no. 4      
5.Jacob WLW. Gamma-glutamyl transpetidase in diseases of liver, cardiovascular system and diabetes­mellitus. Clin Chem Acta 1972;38: 419-434.  Back to cited text no. 5      
6.Rutenberg AM, Goldberg TA, Pineda EP. Serum Gamma- gluta­myl transpeptidase activity in­hepato-biliary pancreatic disease. Gastroenterology 1963;45:43-48.  Back to cited text no. 6      
7.Szczekl.il E, Orlowski M, Szewczwk A. Serum Gamma-glutanyl trans peptidase activity in liver disease_ Gastroenterology 1961;41:353-359.  Back to cited text no. 7      
8.Betro MG, Edward JB. Gamma­glutamyl transpeptidase in disease of.liver and bone. Am J Clin Pathol 1973;60:672-678.  Back to cited text no. 8      
9.Gowenlock AH. Enzymes. In ; MC Murry JR, Gowenlock AH, Mclan­chlari, eds. Varley's Practical Clini­cal Biolemistry. 6th ed. pp. 447-549. Oxford : Heihemann Professional Publishing; 1988.  Back to cited text no. 9      
10.Whiifield JB, Moss DW, Neale Government et al. Changes in plasma Gamma-glutamyl trans­peptidase activity asspciated with alterations in drug metabolism in man. Br Mod 1 1973;1:316-18.  Back to cited text no. 10      



 
 
    Tables

  [Table 1], [Table 2]



 

Top
Print this article  Email this article
Previous article Next article

    

© 2004 - Indian Journal of Medical Sciences
Published by Medknow
Online since 15th December '04