Why does bilirubin increase?
Bilirubin is formed during the breakdown of hemoglobin. In the blood it is in indirect form, then in the liver the enzyme UDP-glucuronyltransferase converts it into direct bilirubin, which is excreted in bile. In Gilbert's syndrome, due to changes in the UGT1A1 gene, the activity of this enzyme is reduced by about two-thirds. While the load on the system is small, bilirubin remains within normal limits or is slightly elevated. During fasting, dehydration, and infections, its level increases and yellowness appears.
- Passed on by inheritance
- Occurs more often in adolescence and young adulthood
- Occurs in a significant portion of the population
- It is detected more often in men than in women
What causes jaundice
Episodes of increased bilirubin are usually associated with circumstances that increase the production of pigment or reduce the liver's ability to bind it. Knowing these factors, many people avoid visible yellowness completely.
- Fasting, long breaks between meals, strict diets
- Dehydration and heat
- Lack of sleep, stress, overwork
- Intense physical activity
- ARVI and other infections
- Alcohol
- Some medications
Symptoms
For many people, Gilbert's syndrome does not manifest itself in any way and is discovered by chance through a blood test. The main visible sign is a slight yellowness of the sclera, less often the skin. Sometimes during these periods fatigue, abdominal discomfort, and loss of appetite are noted, but the direct connection of these complaints with bilirubin is not always obvious.
- Yellowness of the whites of the eyes that occurs in episodes
- Slight yellowness of the skin
- Fatigue during periods of increased bilirubin
- Normal color of urine and stool
Diagnostics
Gilbert's syndrome is suspected when total bilirubin is increased due to the indirect fraction, and other liver parameters and a general blood test are normal. The analysis is worth repeating: fluctuations in bilirubin levels are typical. An ultrasound of the liver and gallbladder is performed to rule out hemolytic anemia and viral hepatitis. In doubtful cases, genetic analysis is performed for the UGT1A1 gene mutation. A liver biopsy is not needed for diagnosis.
- Bilirubin total, direct and indirect
- ALT, AST, GGT, alkaline phosphatase
- Complete blood count, reticulocytes
- Markers of viral hepatitis B and C
- Ultrasound of the liver and gallbladder
- UGT1A1 genetic test according to indications
Is treatment necessary and how to live with Gilbert's syndrome
No special treatment is required: it is not a liver disease and it does not progress. “Liver cleansing”, hepatoprotectors and choleretic agents are not needed. The main thing is to avoid provoking factors. An important practical point: Gilbert's syndrome affects the metabolism of certain drugs, including certain chemotherapy drugs and antivirals, so you should inform your doctor about it before prescribing treatment.
- Eat regularly, don't skip breakfast, avoid fasting
- Drink enough water
- Get enough sleep and maintain a routine
- Limit alcohol
- Tell doctors about your diagnosis before prescribing new medications.
