Gilbert's Syndrome

Also known as Constitutional hepatic dysfunction or Familial nonhemolytic jaundice

What is it?
The liver is an organ that is housed in the right upper side of your abdomen, mostly behind the ribs. It is about the size of a football and has many functions. The function that is important with this disorder is processing old red blood cells.

Bilirubin is a product that remains when old red blood cells are broken down, it first circulates in the blood (unconjugated), is taken up by the liver cells, changed to a different form (conjugated) and then the body gets rid of it in bile. Bile is a fluid made by the liver out of water and other particles that is produced, stored in the gallbladder and eventually arrives in the small intestine. Bile is important for the digestion and absorption of fats and vitamins that are fat soluble. Also, many waste products, such as bilirubin are excreted in bile and then eliminated from the body in a bowel movement.

In Gilbert’s syndrome there are elevated levels of this unconjugated bilirubin present in the blood. These levels can get higher with infection, after not eating and in some women after menstrual periods. With this disorder a specific gene is mutated so bilirubin cannot be conjugated correctly.

Who gets it?
This disorder tends to run in families, and you would be born with it.

What are the symptoms?
It is usually diagnosed in young adults. Sometimes people will present with yellowing of their eyes, this can happen, as the levels of bilirubin rise, because it is pigmented. Often there are no symptoms at all. But you may feel tired, or slight abdominal discomfort.

How is it diagnosed?
Gilbert’s can be diagnosed with lab work. You will have persistent high levels of unconjugated bilirubin with normal blood counts and liver tests. The diagnosis is confirmed if these changes last over time. Genetic testing is available if necessary. Other tests may be performed to make sure that there are not other changes in your liver.

How is it treated?
No treatment is necessary.

You need to be aware that you may have increased side effects with certain drugs. For example, acetaminophen levels can be increased, this was noticed when it was given through the blood, and not just by mouth, but do not take more than the recommended amounts.

You should also be aware of how Gilbert’s syndrome travels through families so your family members do not need to have unnecessary testing.

Interesting….
Some studies show that these increased levels of bilirubin can be protective, possibly because of the antioxidant effect of bilirubin. There are lower levels of atherosclerotic heart disease, colorectal cancer and cancer death in general.

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