Gilbert Syndrome

Gilbert syndrome (also called Gilbert's syndrome) is a common condition where the liver does not process bilirubin, a substance that is produced from the breakdown of your red blood cells. Gilbert syndrome is typically harmless and requires no treatment.

What Is Gilbert Syndrome?

Gilbert syndrome is characterized by elevations of unconjugated bilirubin in the blood, which is usually unrecognized until it is seen in a blood test that may be done for other reasons. Fluctuations in blood bilirubin levels (or hyperbilirubinemia) that are sometimes associated with yellowing of the skin and eyes occur in people with Gilbert syndrome. This mild condition, which is otherwise harmless, is often recognized during adolescence during a routine blood test since many of those affected (about 30%) do not have any symptoms. However, in some people, these episodes are triggered by stress, dehydration, vigorous exercise, hormonal changes, or illness. Other symptoms, although rare, may also accompany yellow tinting of the skin.

What Are the Symptoms of Gilbert Syndrome?

There are usually no symptoms, and unless you take a blood test that specifically looks into your bilirubin levels, you may never find out you have this condition. You may have a blood test that shows your bilirubin high, but this should not cause alarm because bilirubin levels do not rise too much. Some people may experience symptoms such as:

• Jaundice. Jaundice, or yellowing of the skin and eyes, is not common because it occurs only when the bilirubin level goes above a critical level. Bilirubin has a yellow to orange color, and excess levels in the blood causes jaundice, which is more likely to occur if you have an infection, if you are stressed, starved, or vomiting, or if you have undergone surgery.
• Other uncommon symptoms. These include tiredness, weakness, mild abdominal pains, and nausea.

When to See a Doctor

Gilbert syndrome is usually harmless, but jaundice can be a symptom of another serious liver disease. Consult your doctor if you experience jaundice for the first time. If you are diagnosed with Gilbert syndrome, you do not need treatment for jaundice unless you have other unusual symptoms.

What Are the Causes & Risk Factors of Gilbert Syndrome?

Bilirubin (a yellow pigment) is produced when the body breaks down your aged red blood cells. It travels through the bloodstream towards the liver where it is broken down by an enzyme, thus removing it from your bloodstream. Bilirubin is passed into the intestines with the bile and excreted in your stool.

Gilbert syndrome is a genetic disorder that is inherited from your parents. The abnormal gene that is supposed to help control the breakdown of bilirubin in your liver is ineffective gene, so excess bilirubin builds up in the blood. Having the abnormal gene that causes Gilbert syndrome is quite common and many people carry a copy of this gene.

Risk Factors

An episode of jaundice may be triggered by certain factors in people who have Gilbert syndrome. These include:

• Dehydration
• Fasting state
• An infection
• Stress
• Physical exertion
• Lack of sleep
• After surgery
• Menstrual periods

Avoiding some known triggers can help reduce having episodes of jaundice.

How to Live With Gilbert Syndrome

Gilbert syndrome does not require treatment. Although your bilirubin levels may fluctuate and you may experience jaundiceoccasionally, this usually disappears on its own, and does not cause any problems.

Gilbert syndrome is a long-term condition that is not a threat to your health. It is not associated with any complications and it does not increase your risk of liver disease. Symptoms are usually short-lived and self-limiting.

There is no need to modify your diet or your daily activities, except to avoid those that trigger your symptoms.

People with Gilbert's syndrome, however, may be at risk of getting jaundice and other side effects when taking certain medications such as:

• Indinavir and Atazanavir (used for treating HIV infection)
• Statins (cholesterol-lowering drugs) plus gemfibrozil
• Gemfibrozil (another cholesterol-reducing drug)
• Irinotecan (used for treating bowel cancer)

Therefore, medical advice must be sought before taking new medications, and doctors must be informed of your condition.