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Having alcohol dependency: Is Gamma Glutamyl Transferase (GGT) test a reliable indicator?

If you are having dependency on alcohol characterized by intense craving for alcohol, suffer withdrawal symptoms on stopping drinking and feel that there is deterioration in your health, then you need medical help. Your doctor will order various blood tests including liver function tests which consist of tests for liver function testing your bilirubin, albumin, prothrombin time and those for liver damage for checking liver enzymes.

What is GGT?

You definitely require to know about GGT in alcohol dependency. GGT or Gamma Glutamyl Transferase is also known as Gamma Glutamyl Transpeptidase. It is applied for diagnosing and monitoring liver damage in various conditions and presently one of the reliable enzymatic indicators of alcohol dependency.

Present mainly in kidney, liver, and pancreatic cells, the enzyme present in the serum appears to originate mainly from the liver, gall bladder and bile ducts. Conditions such as alcohol induced liver disease, obstructive jaundice (jaundice due to obstruction to the flow of bile, commonly due to gallstones), cholangitis (infection of bile ducts) and cholecystitis (gall bladder inflammation) raise the levels of GGT. It is more sensitive than other enzyme indicators such as alkaline phosphatase, leucine aminopeptidase, aspartate transaminase, and alanine aminotransferase in detecting these conditions; its rise occurs earlier than with these other enzymes and persists longer. It is only moderately raised in infectious hepatitis and in this condition GGT values are less useful diagnostically than are measurements of the other enzymes.

GGT – A reliable indicator of alcohol dependency

Serum GGT levels are used in detecting alcohol-induced liver disease.  Elevated levels of GGT are noted not only in the sera of patients with alcoholic cirrhosis but also in the majority of sera from persons who are heavy drinkers. GGT serves as a dependable screening tool, firstly, for detecting your response to alcohol consumption. Secondly, it helps in finding the changes in your liver which correlate with the levels of serum GGT. Thirdly, changes in serum GGT occur on abstinence from alcohol which provide valuable information regarding your condition can be detected. Lastly, monitoring your abstinence from alcohol while under treatment is also possible with GGT.

Response of GGT to alcohol consumption -  Serum GGT levels depend on the amount and duration of alcohol consumption. If you had a single normal sized drink of alcohol, there is no effect on serum GGT. Consumption of multiple drinks on successive days will lead to a small increase in GGT. If you consume same amount of alcohol with periods of abstinence, it will cause minimal elevation of serum GGT.  It is also beneficial to understand the difference in serum GGT levels between moderate drinkers consuming normally 60 to 80 g/day and non-drinkers. The increase in serum GGT in moderate drinkers who abstained for a month is significantly greater than in the non-drinkers of alcohol.

Relation of GGT to changes in liver -  Drinking alcohol in excess leads to changes in the levels of serum GGT which further leads to changes in liver. If you are a heavy drinker, you most likely have high GGT levels and have increased risk of changes in your liver.  You are likely to show liver cell necrosis, fatty liver, fibrosis, or cirrhosis on liver biopsy. High GGT correlates with different degrees of liver damage or a propensity of induction of liver damage.

Change in GGT on abstinence from alcohol – In case, you are a moderate drinker and abstain from alcohol for a month, a decrease in the value of serum GGT will be observed. The absolute value of the decrease on abstinence is related to the initial GGT value and the magnitude of the increase on relapse is correlated with the value during abstinence. A change in the liver which primes it to increase GGT only after short period of relapse indicates development of fatty liver in response to alcohol and onset of further changes in liver.

Monitoring of abstinence in alcoholics under treatment – GGT is used in monitoring of abstinence if you have alcohol dependency and undergoing treatment for that. It is used either in monitoring your response to therapy or in assessing the effectiveness of the treatment itself. Your feedback with personal information is more effective than general information. Individual reference approach is more important than general reference ranges, which makes the detection of relapse easier. You will be motivated by the role of GGT to understand the harmful nature of your drinking, thereby deciding to change your drinking behaviour.  The decrease in GGT when drinking is reduced may also be helpful in reinforcing the reduction.

Your doctor will consider factors such as your age, gender, weight, smoking status and other individual characteristics to determine your response of your serum GGT to alcohol consumption which will guide further management. However, the role of GGT in screening, investigation, and management of alcohol-related problems remains alike in all cases.  In short, screening for dependence, involves use of questionnaires focused on dependence symptoms and in case of screening for excessive intake or for dependence with current drinking, GGT will detect patients missed by questionnaires. GGT is also the highly valuable marker to assess the risk of mortality and morbidity in such cases. Thus, GGT becomes the most reliable indicator in alcohol dependence.