Gilbert’s syndrome

Date Updated: 10/08/2020

Overview

Gilbert's (zheel-BAYRS) 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 the condition as a result of an inherited gene mutation. You might not know you have Gilbert's syndrome until it's discovered by accident, such as when a blood test shows elevated bilirubin levels.

Gilbert's syndrome requires no treatment.

Symptoms

The most frequent sign of Gilbert's syndrome is an occasional yellowish tinge of the skin and the whites of the eyes as a result of the slightly elevated levels of bilirubin in the blood. In people with Gilbert's syndrome, bilirubin levels may increase and jaundice may become apparent because of:

Illness, such as a cold or the flu
Fasting or eating a very low-calorie diet
Dehydration
Menstruation
Stress
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.

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. When you have an ineffective gene, your blood contains excess amounts of bilirubin because your body doesn't produce enough of the enzyme.

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 the enzyme breaks down the pigment 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.

Risk factors

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 your parents carry the abnormal gene that causes the disorder
You're male

Complications

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 any other condition that impairs the destruction of red blood cells may increase your risk of developing gallstones.

Diagnosis

Your doctor may suspect Gilbert's syndrome if you have unexplained jaundice or if the level of bilirubin is elevated in your blood. Other signs and symptoms that suggest Gilbert's syndrome as well as a number of other liver conditions include dark urine and abdominal pain.

To rule out more-common liver conditions, your doctor may order a complete blood count and 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.

Treatment

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 own with no ill effects.

Lifestyle and home remedies

Certain life events, such as stress, can trigger episodes of higher bilirubin levels in Gilbert's syndrome, leading to jaundice. Taking steps to manage those situations can help keep bilirubin levels 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 that you have 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. Exercise, meditation and listening to music may be helpful.

Preparing for an appointment

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?