Gilbert's (zheel-BAR) syndrome is a common, harmless liver condition in which the liver doesn't properly process bilirubin. Bilirubin is produced by the breakdown of red blood cells.
If you have Gilbert's syndrome — also known as constitutional hepatic dysfunction and familial nonhemolytic jaundice — you're born with it as a result of an inherited gene mutation. You might not know you have the condition until it's discovered by accident, such as when a blood test shows elevated bilirubin levels.
Gilbert's syndrome requires no treatment.
The only indication of Gilbert's disease is that your skin and the whites of your eyes occasionally have a yellowish tinge (jaundice) as a result of the slightly elevated levels of bilirubin in your blood. Some conditions and situations that can increase bilirubin levels, and thereby jaundice, in people with Gilbert's syndrome include:
- Illness, such as a cold or the flu
- Fasting or eating a very low-calorie diet
- Strenuous exercise
- Lack of sleep
When to see a doctor
Make an appointment with your doctor if you have jaundice, which has many possible causes.
An abnormal gene you inherit from your parents causes Gilbert's syndrome. The gene normally controls an enzyme that helps break down bilirubin in your liver. With an ineffective gene, excess amounts of bilirubin build in your blood.
How the body normally processes bilirubin
Bilirubin is a yellowish pigment made when your body breaks down old red blood cells. Bilirubin travels through your bloodstream to the liver, where normally an enzyme breaks down the bilirubin 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 abnormal gene is passed through families
The abnormal gene that causes Gilbert's syndrome is common. Many people carry one copy of this gene. In most cases, two abnormal copies are needed to cause Gilbert's syndrome.
Although it's present from birth, Gilbert's syndrome usually isn't noticed until puberty or later, since bilirubin production increases during puberty. You have an increased risk of Gilbert's syndrome if:
- Both parents carry the abnormal gene that causes the disorder
- You're male
The low level of the bilirubin-processing enzyme that causes Gilbert's syndrome may also increase the side effects of certain medications, since this enzyme plays a role in helping clear these medications from your body.
These medications include:
- Irinotecan (Camptosar), a cancer chemotherapy drug
- Some protease inhibitors used to treat HIV
If you have Gilbert's syndrome, talk to your doctor before taking new medications. Also, having certain types of Gilbert's syndrome may increase your risk of developing gallstones.
Before your appointment, you might want to jot down questions to ask your doctor, including:
- Is my bilirubin level significantly elevated?
- Should I have my bilirubin level tested again?
- Could Gilbert's syndrome cause my signs and symptoms?
- Could the medications I'm taking for other conditions worsen Gilbert's syndrome?
- Can Gilbert's 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's syndrome?
If your doctor suspects Gilbert's syndrome because you have unexplained jaundice or blood tests for other conditions show elevated bilirubin levels, he or she will examine you and ask about symptoms of liver disease, such as abdominal pain or dark urine.
Your doctor may recommend more blood tests to rule out other liver problems that can cause elevated bilirubin. Common blood tests include:
- Complete blood count
- Liver function tests
The combination of normal blood and liver function tests and elevated bilirubin levels is an indicator of Gilbert's syndrome. No other testing usually is needed, although genetic testing can confirm the diagnosis.
Gilbert's syndrome doesn't require treatment. The bilirubin levels in your blood may fluctuate over time, and you may occasionally have jaundice, which usually resolves on its on with no ill effects.
Certain life events, such as stress, can trigger episodes of higher bilirubin levels in Gilbert's syndrome, leading to jaundice. Managing those situations can help keep bilirubin under control.
These steps include:
- Make sure your doctors know you have Gilbert's syndrome. Because Gilbert's syndrome affects the way your body processes certain medications, every doctor you visit needs to know about the condition.
- Eat a healthy diet. Avoid 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, such as exercise, meditation or listening to music.
July 02, 2015
- Chowdhury JR, et al. Gilbert's syndrome and unconjugated hyperbilirubinemia due to bilirubin overproduction. http://www.uptodate.com/home. Accessed March 11, 2015.
- Gilbert syndrome. Genetics Home Reference. http://ghr.nlm.nih.gov/condition/gilbert-syndrome. Accessed March 11, 2015.
- Gilbert syndrome. American Liver Foundation. http://www.liverfoundation.org/abouttheliver/info/gilbertsyndrome/. Accessed March 11, 2015.
- Wittenberg H. Hereditary liver disease: Gallstones. Best Practice & Research Clinical Gastroenterology. 2010;24:747.