Gilbert's Syndrome
Also known as: Gilbert syndrome, Benign unconjugated hyperbilirubinemia, Constitutional hepatic dysfunction
Gilbert's syndrome is a common, harmless inherited condition in which the liver processes bilirubin, a yellow pigment made when old red blood cells break down, more slowly than usual. As a result, bilirubin levels in the blood run mildly high, and during periods of stress, fasting, illness, or dehydration the whites of the eyes or the skin may take on a faint yellow tinge. The liver itself is healthy and functions normally. Many people discover they have Gilbert's syndrome only when a routine blood test shows raised bilirubin. It needs no treatment, does not shorten life, and does not progress to liver disease, though it can occasionally affect how certain medications are handled.
At a Glance
- Common symptoms
- Mild yellowing of the whites of the eyes or skin (jaundice) that comes and goes, Jaundice that is more noticeable after fasting, dehydration, illness, or intense exercise, Tiredness or feeling generally unwell during episodes (reported by some, though not clearly caused by the condition)
- Main treatments
- No medical treatment is required, since the condition is benign, Reassurance and education about what triggers episodes of jaundice, Letting doctors and pharmacists know about the diagnosis, because a few drugs (such as the cancer medicine irinotecan and some HIV medicines) are processed by the same enzyme
- Category
- Genetic · Common; a mild inherited trait often found incidentally on routine blood tests
- See a doctor if
- You notice yellowing of the eyes or skin for the first time, so other causes can be ruled out
Symptoms
Causes
- An inherited variation in the UGT1A1 gene that reduces the activity of the enzyme that processes bilirubin
- Usually requires inheriting the gene variant from both parents
- Episodes are triggered by fasting, dehydration, infection, lack of sleep, stress, or heavy exercise, which temporarily raise bilirubin further
Risk Factors
- A family history of Gilbert's syndrome
- Male sex, as men are diagnosed more often, likely due to differences in bilirubin production
- Onset usually noticed in adolescence or early adulthood, when bilirubin production rises
- No lifestyle factors cause the condition itself
Diagnosis
- Blood tests showing mildly raised unconjugated bilirubin with otherwise normal liver enzymes
- Normal full blood count and tests to rule out red blood cell breakdown (hemolysis)
- Repeat testing over time to confirm the pattern is stable and mild
- Genetic testing for the UGT1A1 variant in uncertain cases, though it is rarely needed
Treatment
- No medical treatment is required, since the condition is benign
- Reassurance and education about what triggers episodes of jaundice
- Letting doctors and pharmacists know about the diagnosis, because a few drugs (such as the cancer medicine irinotecan and some HIV medicines) are processed by the same enzyme
- Supportive: eating regular meals and avoiding prolonged fasting or crash diets
- Supportive: staying well hydrated, particularly during illness or exercise
- Supportive: getting adequate sleep and managing stress, which can reduce visible episodes
Prevention
- The condition is inherited and cannot be prevented
- Avoid skipping meals or very low-calorie diets, which trigger jaundice episodes
- Drink enough fluids, especially when unwell
- Limit alcohol, which can add to bilirubin rises in some people
- Keep a note of your diagnosis in your medical records to avoid unnecessary repeat investigations
When to See a Doctor
- You notice yellowing of the eyes or skin for the first time, so other causes can be ruled out
- Jaundice is accompanied by dark urine, pale stools, itching, or abdominal pain, which suggests a different liver or bile duct problem
- You have unexplained fatigue, weight loss, or persistent nausea
- You are starting a new medication and are unsure whether it interacts with Gilbert's syndrome
Frequently Asked Questions
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