Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2016; 8(36): 1629-1636
Published online Dec 28, 2016. doi: 10.4254/wjh.v8.i36.1629
Enzyme pattern of biliary colic: A counterintuitive picture
Elad Resnick, Shimon Shteingart, Bernardo Melamud, Tali Bdolah-Abram, Todd Zalut, Adrian Reuben, Yoav Lurie
Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel
Shimon Shteingart, Department of Pathology, Share’e Zedek Medical Center, Jerusalem 91031, Israel
Bernardo Melamud, Digestive Disease Institute, Share’e Zedek Medical Center, Jerusalem 91031, Israel
Tali Bdolah-Abram, Department of Social Medicine, Hebrew University, Hadassah Hospital, Kiryat Hadassah, Jerusalem 91120, Israel
Todd Zalut, Department of Emergency Medicine, Share’e Zedek Medical Center, Jerusalem 91031, Israel
Adrian Reuben, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29425-2900, United States
Yoav Lurie, Liver Unit, Digestive Disease Institute, Share’e Zedek Medical Center, Jerusalem 91031, Israel
Author contributions: Resnick E, Shteingart S and Lurie Y designed the research; Resnick E, Zalut T, Melamud B and Lurie Y provided the clinical data; Resnick E, Shteingart S, Bdolah-Abram T and Lurie Y analyzed and modeled the data; Resnick E, Shteingart S, Reuben A and Lurie Y wrote the paper.
Institutional review board statement: This was an observational chart review and was approved by the Share’e Zedek Medical Center’s Helsinki committee (number: p 92/13).
Informed consent statement: Not needed, as no patients were contacted.
Conflict-of-interest statement: None.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at yoav@szmc.org.il. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoav Lurie, MD, Head of Liver Unit, Digestive Disease Institute, Share’e Zedek Medical Center, 12 Shmu’el Bait Street, Jerusalem 91031, Israel. yoav@szmc.org.il
Telephone: +972-2-6555035 Fax: +972-2-6555359
Received: June 29, 2016
Peer-review started: July 1, 2016
First decision: September 5, 2016
Revised: October 2, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: December 28, 2016

To evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary colic.


Files were reviewed of 1039 patients who were admitted to the Share’e Zedek Medical Center emergency department between the years 2012-2013, and received the coding of acute biliary disease. Of these, the first 100 cases were selected that met the following criteria: (1) a diagnosis of biliary colic or symptomatic cholelithiasis; (2) at least two biochemical blood tests performed; and (3) 18 years of age or older. Patients with other acute biliary diseases were excluded. The biochemical profile of the patients was analyzed as were their clinical and radiological findings.


Three-quarters of the patients were women, whose average age of 37 years was younger than the average of the men, at 50 years. According to their histories, 47% of the patients had previously known cholelithiasis. Pain in either the right upper quadrant or the epigastrium was the presenting symptom in 93% cases. The greatest change in serum biochemical results was seen during the first day of the patients’ admissions. Alanine aminotransferase (ALT) showed the highest initial rise above the reference range, followed by aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), bilirubin and alkaline phosphatase (ALKP) - all these increases were statistically significant (P < 0.05). AST showed the sharpest decline followed by bilirubin and ALT. GGT and ALKP did not fall. A sharp rise and fall in liver enzymes, especially during the first day, most prominently in AST and ALT, was seen in 70% percent of cases. In 65% of cases trans-abdominal sonography did not give diagnostic findings.


Serial serum liver enzyme measurements are helpful in the initial diagnosis of acute biliary colic.

Keywords: Biliary colic, Symptomatic cholelithiasis, Gallstones, Liver enzymes, Aspartate aminotransferase, Alanine aminotransferase, Enzyme pattern, Diagnostic tool, Emergency department

Core tip: Gallstones are prevalent in affluent countries, more so in women than in men, and their prevalence increases with age. A large proportion of patients presenting to the emergency department with epigastric or right upper quadrant (RUQ) pain present a diagnostic challenge, especially when they belong to the older age group. We found that serial liver and biliary enzyme measurements reveal a characteristic pattern that helps the clinician determine quickly, cheaply and safely that the cause of RUQ/epigastric pain is biliary colic, in 71% of the patients. Serial enzyme testing is a useful adjunct to other diagnostic tools, for the diagnosis of acute upper abdominal pain.