Gilbert syndrome

Overview

Gilbert syndrome is a harmless liver condition in which the liver doesn't properly process bilirubin. Bilirubin is a substance produced by the breakdown of red blood cells.

Gilbert (zheel-BAYR) syndrome is a genetic condition passed down from your parents. You might not know you have Gilbert syndrome until it's discovered by accident, such as when a blood test shows raised bilirubin levels.

Gilbert syndrome needs no treatment.

Symptoms

The most common sign of Gilbert syndrome is an occasional yellowish tinge of the skin and the whites of the eyes, called jaundice. Jaundice is a result of slightly higher levels of bilirubin in the blood.

In people with Gilbert syndrome, bilirubin levels may increase due to:

• Illness, such as a cold or the flu.
• Fasting or eating a very low-calorie diet.
• Dehydration.
• Menstruation.
• Strenuous exercise.
• Stress.

When to see a doctor

Make an appointment with a healthcare professional if you have jaundice, which has many possible causes.

Causes

Gilbert syndrome is caused by a modified gene someone inherits from their parents. This gene usually controls an enzyme that helps break down bilirubin in the liver. When someone has this ineffective gene, their blood contains too much bilirubin. This is because the body isn't producing enough of the enzyme.

How the body processes bilirubin

Bilirubin is a yellowish pigment made when the body breaks down old red blood cells. Bilirubin travels through the bloodstream to the liver, where the enzyme breaks down the pigment and removes it from the bloodstream.

The bilirubin passes from the liver into the intestines with bile. It's then excreted in stool. A small amount of bilirubin remains in the blood.

How the modified gene is passed through families

The modified gene that causes Gilbert syndrome is common. Many people carry one copy of this gene. In most cases, two modified copies are needed to cause Gilbert syndrome.

Risk factors

Although it's present from birth, Gilbert syndrome usually isn't noticed until puberty or later. This is because bilirubin production increases during puberty. Risk factors for Gilbert syndrome include:

• Both parents carry the modified gene that causes the disorder.
• Being male.

Complications

The low level of the bilirubin-processing enzyme that causes Gilbert syndrome also may increase the side effects of certain medicines, since this enzyme plays a role in helping clear these medicines from the body.

These medicines include:

• Irinotecan (Camptosar), a cancer chemotherapy drug.
• Some protease inhibitors used to treat HIV.

If you have Gilbert syndrome, talk to a healthcare professional before taking new medicines. Also, having any other condition that affects the destruction of red blood cells may increase the risk of developing gallstones.

Diagnosis

A healthcare professional may suspect Gilbert syndrome if a person has unexplained jaundice or if the level of bilirubin is elevated in the blood. Other symptoms that suggest Gilbert syndrome as well as a few other liver conditions include dark urine and belly pain.

To rule out more-common liver conditions, a healthcare professional may order a complete blood count and liver function tests.

The combination of standard blood counts and liver enzymes with an elevated bilirubin level is an indicator of Gilbert syndrome. No other testing usually is needed, although genetic testing can confirm the diagnosis.

Treatment

Gilbert syndrome doesn't need treatment. The bilirubin levels in the blood may go up and down over time. Someone with Gilbert syndrome may sometimes have jaundice, which usually resolves on its on with no ill effects.

Self care

Certain life events, such as stress, can trigger episodes of higher bilirubin levels in Gilbert syndrome, leading to jaundice. Taking steps to manage those situations can help keep bilirubin levels under control.

These steps include:

• Make sure your health care providers know you have Gilbert syndrome. Because Gilbert syndrome affects the way your body processes certain medicines, every healthcare professional you visit needs to know that you have the condition.
• Eat a healthy diet. Don't follow extremely low-calorie diets. Stick to a routine eating schedule, and avoid fasting or skipping meals.
• Manage stress. Find ways to deal with the stresses in your life. Exercise, meditation and listening to music may be helpful.

Preparing for your appointment

Before your appointment, you might want to jot down questions to ask, including:

• Is my bilirubin level significantly elevated?
• Should I have my bilirubin level tested again?
• Could Gilbert syndrome cause my symptoms?
• Could the medicines I'm taking for other conditions worsen Gilbert syndrome?
• Can Gilbert syndrome cause complications or lead to liver damage?
• Do I have a higher risk of gallstones?
• Is there anything I can do to maintain a low bilirubin level?
• Is jaundice harmful?
• How likely is it that my children will inherit Gilbert syndrome?