Q: I am a 39 years old man who was diagnosed with hiatus hernia - along with inflammatory bowel syndrome (IBS) around two and a half years back and have been on medication off and on since then. I am on proton pump inhibitors and taking Colospa-R for the last 4-5 months, since the motions were irregular and there were haemorrhoids at the anal opening. There has been marked improvement in bowel movements and virtually no anal bleeding while passing stool since under the above medication. For the last year I have been taking quarterly liver function and cholesterol tests. The liver function parameters like SGPT and SGOT have been generally within range but triglycerides and cholesterol were on the higher side. I have noticed an increase in the alkaline phosphatase count from around 100-130 to a range of 230-250. The doctors told me that it is of not much concern, since the results are interpreted together with other parameters. Is there any cause for concern on account of raised ALP? Please advise.

A:Alkaline phosphatase enzyme has more than one source; the most important of these are liver and bone. Thus enzyme can be tested for its origin, i.e., either bone related or liver related. I suggest you contact your chemical laboratory to fractionise your serum alkaline phosphatase. If it still high and liver related, it means there is mild obstruction to the bile flow, the commonest of the causes for this being turbid bile leading to gall stone formation. I suggest you consult a gastro-enterologist (or a rheumatologist if bone related) for appropriate advice and relevant tests.