Gilbert's Syndrome (Meulengracht Syndrome)
Gilbert's Syndrome is a common metabolic disorder in which an enzyme defect causes the bile pigment bilirubin to be metabolized and excreted to an insufficient extent. This leads to raised bilirubin levels. Gilbert's Syndrome does not cause liver damage and is therefore not considered a liver disease strictly speaking. As no organs are damaged, people with Gilbert's Syndrome have a normal life expectancy. Symptoms and drug intolerance can be triggered by Gilbert's Syndrome, which may have an impact on other diseases and their treatment.
Raised bilirubin levels lead to a mild yellow colouring of the skin and the whites of the eyes (jaundice). However, in Gilbert's Syndrome, this is only temporary. Bilirubin levels can also increase in the event of other diseases, when liver function decreases.
In Gilbert's Syndrome, symptoms normally appear episodically and then disappear again. Less frequently symptoms such as extreme fatigue, apathy, disturbed concentration and significant nausea can arise.
Influence on the treatment of other illnesses
As this metabolic disorder causes certain medicines to be metabolised more poorly, this can lead to much more pronounced side effects. The following medicines are known to be affected by Gilbert's Syndrome: The following drugs are known to be affected by Meulengracht's disease: irinotecan (anti-cancer drug), oestrogen-containing hormones, buprenorphine, anthraquinones, flavonoids, and the HIV drugs indinavir and atazanavir. When assessing liver injury due to another liver disease, Gilbert's Syndrome affects the values used to measure actual liver injury. If another illness is present in conjunction with Gilbert's Syndrome (e.g. sickle cell anaemia), this can raise the chances of gallstones forming.
If the only elevated value is bilirubin, this is an indication of Gilbert's Syndrome, unless there is reason to believe that liver disease might be present. Other diseases of the liver and haemolysis should be excluded because these can also lead to raised bilirubin levels. In Gilbert's Syndrome, bilirubin levels also increase during fasting and on a low-fat diet. A genetic test can definitively confirm Gilbert's Syndrome.
Gilbert's Syndrome cannot be cured. However, the symptoms and problems associated with the disease can be alleviated. Avoiding alcohol, nicotine, sleep disruption and long periods without eating can have a positive effect on the increase in bilirubin.