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Can Methotrexate Contribute To Elevated Liver Enzymes?

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Posted on Wed, 23 Sep 2015
Question: My son with Crohn's is on methotexrate (he's been taking 20 mg/week for 9 weeks) and just had a test with his ALT level at about 100. AST was lightly elevated but not as much. He's a long distance runner, and had run about 8 miles about 2 hours before the test and had woken up with a sore throat and by that afternoon had a full blown viral cold/cough. Could any of these explain the elevation? He also was having a flare up of SIBO and diarrhea that week, esp the previous day.
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Answered by Dr. Mohammed Taher Ali (10 hours later)
Brief Answer:
The raised enzymes could be due to long distance running.

Detailed Answer:

Dear Sir, Hi & Welcome.
I appreciate your concern for your beloved son.

After having gone through your query, I am of the opinion that

1. The raised liver enzymes (ALT & AST) may be due to long distance running. Long distance running may cause muscles this enzyme to be released during the extra work.
However, possibility of Methotrexate causing the raised enzymes also should be kept in mind. Hence it is hereby advised to kindly repeat the the liver function tests after 2-3 weeks.

2. Small intestinal bacterial overgrowth (SIBO) is an important complication of Crohn's disease. This is attributable to decreased immunity caused by the disease itself or by Methotrexate. SIBO develops when the normal defence mechanisms that control the intestinal bacterial populations are disrupted due to deficient immunity.

Hope to have clarified the doubts regarding the raised enzymes and SIBO.

However I shall be happy to answer if you have any follow-up query.


Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Mohammed Taher Ali

General & Family Physician

Practicing since :1988

Answered : 6261 Questions

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Can Methotrexate Contribute To Elevated Liver Enzymes?

Brief Answer: The raised enzymes could be due to long distance running. Detailed Answer: Dear Sir, Hi & Welcome. I appreciate your concern for your beloved son. After having gone through your query, I am of the opinion that 1. The raised liver enzymes (ALT & AST) may be due to long distance running. Long distance running may cause muscles this enzyme to be released during the extra work. However, possibility of Methotrexate causing the raised enzymes also should be kept in mind. Hence it is hereby advised to kindly repeat the the liver function tests after 2-3 weeks. 2. Small intestinal bacterial overgrowth (SIBO) is an important complication of Crohn's disease. This is attributable to decreased immunity caused by the disease itself or by Methotrexate. SIBO develops when the normal defence mechanisms that control the intestinal bacterial populations are disrupted due to deficient immunity. Hope to have clarified the doubts regarding the raised enzymes and SIBO. However I shall be happy to answer if you have any follow-up query.