Gilbert's (zheel-BAYRZ) syndrome is a common, mild liver
disorder in which the liver doesn't properly process a substance
called bilirubin, which is produced by the breakdown of red
blood cells. Also known as constitutional hepatic dysfunction,
unconjugated benign bilirubinemia and familial nonhemolytic
jaundice, Gilbert's syndrome typically doesn't require treatment
or pose serious complications.
In fact, Gilbert's syndrome is usually not considered a disease
because of its benign nature. Most people who have the disorder
find out by accident, when they have a blood test that shows
elevated bilirubin levels.
Gilbert's syndrome affects 3 percent to 10 percent of the U.S.
population. More males than females have the condition.
Signs and Symptoms
As an inherited condition, Gilbert's syndrome is present from
birth. Although it rarely causes symptoms, it may raise
bilirubin enough to produce mild jaundice.
While the bilirubin does not reach a dangerous level, jaundice,
if it occurs, may look disconcerting. Typically, excess
bilirubin turns the whites of your eyes yellow before affecting
your skin. If the bilirubin level keeps rising, your skin may
develop a yellowish tinge.
A number of factors may increase bilirubin if you have Gilbert's
syndrome. These may include:
Illness, including infections, such as the cold or flu
Fasting or skipping meals
Some people with Gilbert's experience episodes of fatigue,
weakness and abdominal pain. However, it's not known if
Gilbert's actually causes such symptoms, or if they're related
to stress or other conditions.
Your liver naturally produces bilirubin, which is a yellowish
pigment. It's a normal waste product from the breakdown of old
red blood cells. Bilirubin travels through your bloodstream to
the liver. In normal functioning, an enzyme in liver cells helps
break down the bilirubin and remove it from the bloodstream. The
bilirubin passes from the liver into the intestines with bile.
It's then excreted by the body through stool. A small amount of
bilirubin remains in the blood.
People with Gilbert's syndrome, though, inherit an abnormal gene
that controls the enzyme that helps break down bilirubin. This
gene abnormality results in a lower level of the enzyme.
Consequently, excessive amounts of a form of bilirubin called
unconjugated bilirubin can build up in the blood.
Some experts believe that Gilbert's syndrome is simply a normal
variation in the range of bilirubin levels.
Gilbert's syndrome is an inherited genetic disorder. Development
of the disorder isn't related to lifestyle habits or
The only way to theoretically prevent the condition is to keep
parents from passing the abnormal gene that causes it on to
their children. But more than half the people in the general
population carry one copy of this abnormal gene, making it very
common. If two people with this abnormal gene have a child, they
may pass along the genetic defect that causes Gilbert's — but
not always. Not everyone who has two copies of this abnormal
gene gets Gilbert's syndrome. This means you may have the
condition without a family history of it. In contrast, everyone
with Gilbert's does have two copies of this abnormal gene.
Gilbert's syndrome can cause episodes of jaundice. However, the
jaundice is usually mild and goes away on its own. There are no
other known complications of the condition itself, and it won't
damage your liver.
The low level of the bilirubin-processing enzyme may cause
increased side effects with certain medications. The same enzyme
also helps the body eliminate certain medications. In
particular, irinotecan (Camptosar), a medication used to treat
colon cancer, can reach toxic levels in people with Gilbert's,
causing severe diarrhea. Because of this potential effect with
certain medications, talk to your doctor before taking any new
medications when you have Gilbert's syndrome.
Other than the chance of inheriting abnormal genes, there are no
known risk factors that increase the likelihood that you'll get
Screening and Diagnosis
If you have jaundice, your health care provider may suspect that
you have Gilbert's syndrome or perhaps another condition. Often,
though, Gilbert's is found purely by accident when you have
blood work for other health reasons, such as an illness, surgery
or to buy a life insurance policy. Although it's present from
birth, Gilbert's syndrome usually isn't diagnosed until puberty
or later, when bilirubin production increases.
Your doctor may do a physical exam and order additional blood
tests. With Gilbert's, unless you have an episode of jaundice,
there are no physical signs or symptoms.
Common blood tests include:
Complete blood count
Liver function tests
A diagnosis of Gilbert's syndrome can usually be made from blood
tests. With Gilbert's, all of the results will typically be
normal except for the mildly increased level of unconjugated
When you have Gilbert's syndrome, the level of bilirubin in your
blood may fluctuate. It's not always higher than the normal
range. If your initial blood test shows a normal level of
bilirubin, your doctor may suggest repeating the tests a couple
Rarely, your doctor may suggest other tests, including:
An ultrasound of your liver
Fasting over a 24-hour period to see if that increases
Genetic testing, which is not widely available, to check for
the abnormal gene that causes Gilbert's
When you have jaundice or a high bilirubin level, it's important
to ensure that you don't have a more serious liver condition.
Your doctor may recommend other tests to check for such
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