Gilbert’s syndrome is caused by lack or deficiency of an enzyme uridine-diphosphate glucuronosyltransferase or UGT.
This enzyme is responsible for converting fat soluble free or unconjugated bilirubin into water soluble conjugated bilirubin which is then excreted from the body. Bilirubin thus helps in excretion of the heme derived from the dead red blood cells.
Diagnosis of Gilbert’s syndrome
Gilbert’s syndrome is usually mild and in many cases does not produce any symptom. In fact, most cases are diagnosed as part of routine work up.
The diagnostic feature is normal liver function tests with rise of unconjugated bilirubin alone.
Who treats Gilbert’s syndrome?
Gilbert’s syndrome is usually managed by a general physician, internist or a gasteroenterologist.
Types of treatment for Gilbert’s syndrome
No treatment is needed for majority of patients. There is no health problems associated with this condition and thus most patients do not need any therapy.
Patients with Gilbert’s syndrome have a normal life expectancy and do not have a raised risk of other liver ailments.
Steps may be taken to manage jaundice though.
Jaundice, if caused by Gilbert’s syndrome, is managed at home with bed rest, healthy diet and adequate fluids. There is no need for pharmacological therapy for jaundice caused by Gilbert’s syndrome.
Prevention of Gilbert’s syndrome
Prevention of Gilbert’s syndrome is not possible as it is a genetically inherited condition.
However, complications and severe side effects may be prevented to lead a more normal life.
In order to prevent attacks of jaundice patients are advised to avoid dieting and dehydration, extremes of emotional stress or anxiety, heavy physical exercise and exertion and irregular or sleep deprived days.
Infectious illnesses need to be treated early to prevent complications.
Patients are advised to eat a well balanced and healthy diet, drink plenty of clear fluids like water and fruit juice, avoid fatty or sugary foods or foods that they cannot tolerate.
Some patients may also require vitamins and supplements. Alcohol should be avoided. Any patient with liver disease should avoid alcohol altogether or take it in moderation and with caution to prevent other liver diseases and further liver damage.
Factors that may trigger jaundice
Some drugs may precipitate jaundice in patients with Gilbert’s syndrome. These include:
- Atazanavir and indinavir (used against HIV infection),
- Gemfibrozil or combination of Gemfibrozil with Statins (used for lowering cholesterol)
- Irinotecan (used against advanced bowel cancer and other cancers)
These should be avoided in patients with Gilbert’s syndrome.
All medications should be taken on prescription. Patient is advised to consult his or her doctor before taking an over the counter medicine or a herbal preparation that may damage the liver.
Drugs like acetaminophen or Tylenol used against fever may also be dangerous for patients with liver disease as they raise the risk of liver damage in overdose. (1-5)
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)