What are the most common causes of elevated liver enzymes. How do medications, lifestyle factors, and medical conditions contribute to high liver enzyme counts. What are the implications of abnormal liver function tests for overall health.

Understanding Liver Enzymes: What They Are and Why They Matter

Liver enzymes are specialized proteins that catalyze chemical reactions within the liver. These enzymes play crucial roles in various metabolic processes, including detoxification, protein synthesis, and bile production. When liver cells are damaged or inflamed, these enzymes can leak into the bloodstream, resulting in elevated levels that can be detected through blood tests.

The most commonly measured liver enzymes include:

• Alkaline Phosphatase (ALP)
• Alanine Transaminase (ALT)
• Aspartate Transaminase (AST)
• Gamma-glutamyl Transferase (GGT)

Elevated liver enzymes can be indicative of various underlying health issues, ranging from temporary conditions to more serious liver diseases. Understanding the causes of high liver enzymes is essential for proper diagnosis and treatment.

Medications and Their Impact on Liver Enzyme Levels

Pain Medications: A Double-Edged Sword

While pain medications like acetaminophen are generally safe when used as directed, excessive use can lead to liver damage. How does this occur? Acetaminophen is metabolized by the liver, and when taken in large quantities, it can overwhelm the liver’s ability to process the drug safely. This can result in the accumulation of toxic byproducts, potentially causing severe liver injury.

It’s important to note that individuals who consume alcohol regularly should be particularly cautious with acetaminophen use. The combination of alcohol and acetaminophen can increase the risk of liver damage. In extreme cases, this can lead to acute liver failure and even death.

Statins: Balancing Cholesterol Control and Liver Health

Statin drugs, widely prescribed to lower cholesterol levels, have been associated with mild liver enzyme elevations in some patients. While these elevations are often transient and resolve on their own, they highlight the importance of liver function monitoring in patients taking statins.

What should you do if your liver enzymes are elevated due to statin use? It’s crucial not to discontinue your medication abruptly without consulting your healthcare provider. Your doctor may recommend periodic liver function tests to monitor your enzyme levels and adjust your treatment plan if necessary.

Cardiovascular Conditions and Liver Enzyme Elevations

Heart failure can have significant implications for liver health. How does this occur? In cases of severe heart failure, reduced cardiac output can lead to decreased blood flow to the liver. This reduction in hepatic blood flow can result in acute liver injury and, in some cases, contribute to the development of liver scarring or fibrosis.

Additionally, heart failure can cause hepatic congestion, where blood backs up in the liver due to increased central venous pressure. This congestion can lead to elevated liver enzymes as the liver cells become stressed and damaged.

Viral Hepatitis: A Major Cause of Liver Enzyme Elevations

Hepatitis A: Acute Inflammation and Enzyme Elevations

Hepatitis A is a viral infection that primarily targets the liver, causing inflammation and elevated liver enzymes. How does hepatitis A affect liver enzyme levels? The virus attacks liver cells, leading to increased levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the bloodstream.

While hepatitis A typically doesn’t cause long-term liver damage, the acute phase of the infection can result in a temporary but significant elevation of liver enzymes. This elevation is often a result of the body’s immune response to the virus and the subsequent inflammation of liver tissue.

Hepatitis B: Chronic Infection and Liver Cell Damage

Hepatitis B is a more serious viral infection that can cause both acute and chronic liver disease. How does hepatitis B lead to elevated liver enzymes? The hepatitis B virus directly infects liver cells, leading to cell damage and death. As these damaged cells release their contents into the bloodstream, liver enzyme levels rise.

In chronic hepatitis B infections, the ongoing inflammation and immune response can result in persistent elevation of liver enzymes. This chronic elevation is often associated with progressive liver damage and an increased risk of complications such as cirrhosis and liver cancer.

Hepatitis C: Silent Liver Damage and Enzyme Elevations

Hepatitis C is often referred to as a “silent” infection because it can cause liver damage for years before symptoms become apparent. How does hepatitis C affect liver enzyme levels? The hepatitis C virus primarily targets liver cells, leading to chronic inflammation and cell death. As liver cells are damaged, enzymes such as ALT and AST leak into the bloodstream, resulting in elevated levels on blood tests.

In chronic hepatitis C infections, liver enzyme levels may fluctuate over time but often remain persistently elevated. These elevated enzymes can be an important indicator of ongoing liver damage and the need for treatment to prevent further complications.

Metabolic Disorders and Liver Health

Non-Alcoholic Fatty Liver Disease: A Growing Concern

Non-alcoholic fatty liver disease (NAFLD) has become increasingly prevalent in recent years, paralleling the rise in obesity and metabolic syndrome. How does NAFLD lead to elevated liver enzymes? In NAFLD, excess fat accumulates in liver cells, causing inflammation and damage. This damage results in the release of liver enzymes into the bloodstream, particularly ALT and AST.

As NAFLD progresses, it can lead to a more severe condition called non-alcoholic steatohepatitis (NASH), characterized by liver inflammation and fibrosis. In advanced stages, NASH can progress to cirrhosis, a condition of irreversible liver scarring that significantly impairs liver function.

Obesity: A Risk Factor for Liver Enzyme Elevations

Obesity has been strongly associated with elevated liver enzymes, even in the absence of other liver diseases. Why do obese individuals have a higher prevalence of elevated liver enzymes? There are several factors at play:

1. Insulin resistance: Obesity often leads to insulin resistance, which can promote fat accumulation in the liver.
2. Chronic inflammation: Adipose tissue in obese individuals produces pro-inflammatory substances that can affect liver function.
3. Oxidative stress: Obesity is associated with increased oxidative stress, which can damage liver cells.
4. Altered lipid metabolism: Obesity can disrupt normal lipid metabolism, leading to fat accumulation in the liver.

These factors combined can result in liver cell damage and subsequent elevation of liver enzymes in obese individuals.

Alcohol-Related Liver Damage and Enzyme Elevations

Alcoholic hepatitis is a serious condition caused by excessive alcohol consumption. How does alcohol lead to elevated liver enzymes? When alcohol is metabolized in the liver, it produces toxic byproducts that can directly damage liver cells. This damage causes inflammation and the release of enzymes into the bloodstream.

In alcoholic hepatitis, AST and ALT levels are typically elevated, with AST often higher than ALT. This pattern can help differentiate alcoholic liver disease from other causes of liver enzyme elevations. Chronic alcohol abuse can lead to progressive liver damage, culminating in cirrhosis and potentially life-threatening complications.

Autoimmune Hepatitis: When the Immune System Attacks the Liver

Autoimmune hepatitis is a chronic inflammatory condition where the body’s immune system mistakenly attacks liver cells. How does this autoimmune response affect liver enzyme levels? The immune-mediated destruction of liver cells leads to the release of enzymes into the bloodstream, resulting in elevated levels of transaminases (ALT and AST).

In addition to elevated liver enzymes, autoimmune hepatitis is characterized by the presence of specific autoantibodies in the blood. These antibodies, along with elevated liver enzymes and other clinical features, help in diagnosing and monitoring the progression of the disease.

Rare Causes of Elevated Liver Enzymes

While the conditions discussed above account for the majority of cases of elevated liver enzymes, there are several less common causes that should be considered in certain situations:

• Hemochromatosis: A genetic disorder causing excessive iron accumulation in the liver
• Wilson’s disease: A rare inherited disorder of copper metabolism affecting the liver
• Alpha-1 antitrypsin deficiency: A genetic condition that can lead to liver and lung disease
• Certain medications: Some antibiotics, antifungal drugs, and herbal supplements can cause liver enzyme elevations
• Celiac disease: An autoimmune disorder triggered by gluten that can affect liver function

These rarer causes of elevated liver enzymes often require specialized testing and expertise to diagnose and manage effectively.

Diagnostic Approach to Elevated Liver Enzymes

When faced with elevated liver enzymes, healthcare providers typically follow a systematic approach to identify the underlying cause. What steps are involved in diagnosing the cause of elevated liver enzymes?

1. Detailed medical history: This includes questions about alcohol consumption, medication use, and family history of liver disease.
2. Physical examination: Looking for signs of chronic liver disease such as jaundice, spider angiomas, or abdominal swelling.
3. Additional blood tests: These may include tests for viral hepatitis, autoimmune markers, and other liver function tests.
4. Imaging studies: Ultrasound, CT, or MRI scans can help visualize the liver and detect structural abnormalities.
5. Liver biopsy: In some cases, a small sample of liver tissue may be needed for definitive diagnosis.

The specific diagnostic approach will depend on the individual patient’s presentation and the suspected underlying cause of the elevated liver enzymes.

Management and Treatment of Elevated Liver Enzymes

The management of elevated liver enzymes depends on the underlying cause. What are some general principles in treating elevated liver enzymes?

• Addressing modifiable risk factors: This may include weight loss, alcohol cessation, or discontinuation of hepatotoxic medications.
• Treating underlying conditions: For example, antiviral therapy for viral hepatitis or immunosuppressive drugs for autoimmune hepatitis.
• Lifestyle modifications: Adopting a healthy diet, increasing physical activity, and avoiding substances that can harm the liver.
• Regular monitoring: Periodic blood tests to track liver enzyme levels and assess treatment response.
• Liver-protective medications: In some cases, drugs that support liver function may be prescribed.

It’s important to note that treatment should always be tailored to the individual patient and the specific cause of their elevated liver enzymes. Close collaboration between the patient and their healthcare provider is essential for optimal management and outcomes.

Prevention Strategies for Maintaining Healthy Liver Enzyme Levels

While not all causes of elevated liver enzymes are preventable, there are several strategies individuals can adopt to promote liver health and reduce the risk of enzyme elevations. What are some key prevention strategies?

• Maintain a healthy weight: Obesity is a significant risk factor for non-alcoholic fatty liver disease and elevated liver enzymes.
• Limit alcohol consumption: Excessive alcohol intake is a leading cause of liver damage and enzyme elevations.
• Exercise regularly: Physical activity can help improve insulin sensitivity and reduce fat accumulation in the liver.
• Follow a balanced diet: A diet rich in fruits, vegetables, whole grains, and lean proteins supports liver health.
• Avoid unnecessary medications: Use over-the-counter pain relievers and other medications only as directed.
• Get vaccinated: Hepatitis A and B vaccines can prevent these viral infections that can lead to liver damage.
• Practice safe sex and avoid sharing needles: These measures can reduce the risk of contracting hepatitis B and C.
• Manage chronic conditions: Properly controlling conditions like diabetes and heart disease can help protect liver health.

By implementing these preventive strategies, individuals can take proactive steps to maintain healthy liver function and potentially avoid the complications associated with elevated liver enzymes.

The Future of Liver Enzyme Research and Management

As our understanding of liver function and disease continues to evolve, new approaches to diagnosing and managing elevated liver enzymes are emerging. What are some promising areas of research in this field?

• Non-invasive biomarkers: Researchers are working to develop more sensitive and specific blood tests to assess liver health without the need for invasive procedures.
• Advanced imaging techniques: New imaging modalities may provide more detailed information about liver structure and function, aiding in early diagnosis and treatment planning.
• Targeted therapies: As we gain a better understanding of the molecular mechanisms underlying liver diseases, more targeted and effective treatments may become available.
• Artificial intelligence: Machine learning algorithms may help in interpreting complex liver function data and predicting disease progression.
• Personalized medicine: Genetic and molecular profiling may allow for more individualized approaches to managing elevated liver enzymes and underlying liver diseases.

These advancements hold the promise of improving our ability to detect, diagnose, and treat liver disorders more effectively, potentially reducing the long-term impact of elevated liver enzymes on overall health.

12 Causes of High Liver Enzymes | Updated 2023

The liver is a crucial part of our body. Therefore, it is necessary to take care of our internal organs. However, it has been noticed that sedentary lifestyles have increased the rate of liver diseases. Almost 257 million people are living with liver conditions worldwide. These numbers are huge to resolve the problem. Liver enzymes are a protein in the liver that speed up the reactions of some chemicals. Various conditions such as Liver issues, Chronic health issues, medications, and infections can cause Causes of High Liver Enzymes. In the case of an inhibitory process, this can result in severe problems. Therefore, it is essential to know the causes of high liver enzymes and what to do to prevent them.

If you are looking for a doctor’s advice, watch the video below.

Table of Contents

What are elevated liver enzymes?

Individuals with more liver enzymes in the blood may develop high liver enzymes. These increased levels of liver enzymes are not normal and may cause transient or indicative medical conditions such as hepatitis or liver disease.

Different types of liver enzymes are listed below: 

• Alkaline Phosphatase (ALP)
• Alanine Transaminase (ALT)
• Aspartate Transaminase (AST) 
• Gamma-glutamyl Transferase (GGT)

There is a copious cause that elevates the liver enzymes in the blood. Let’s glance at a few of them. 

Also read: Top 10 Cod Liver Oil Benefits

Causes of Elevated Liver Enzymes – 

High liver enzymes often occur due to harmless health conditions. These conditions are readily treated or resolved on their own. Among the most prevalent Causes of High Liver Enzymes are: 

1. Pain Medications – 

Though taking acetaminophen for pain has little effect on the liver, taking too much can disrupt the function of the liver. People who drink alcohol regularly should avoid taking acetaminophen, which may cause an accumulation of toxic substances in the body.

It can lead to death also if severe liver damage occurs with pain medications. 

2. The statins Drugs – 

Statins drugs are used to decrease cholesterol which shows milder liver damage. Therefore, liver enzymes should be monitored if a person takes statin drugs. Do not abruptly stop your medications if you see your enzymes raised due to cholesterol medicine. 

3. Heart failure –

Many cases have shown low cardiac output has resulted in a reduction of hepatic flow. This leads to acute hepatic failure, which causes scarring of the liver. It develops the liver enzymes’ elevation in the body. When hepatic congestion occurs, that increases central venous pressure and raises liver enzymes. 

4. Hepatitis A –

Hepatitis A is a liver condition when a virus starts attacking the liver, which causes inflammation. This raised alanine aminotransferase and aspartate aminotransferase liver enzymes. Although it doesn’t affect in the long term, sudden functional loss of the liver results in the increase of enzymes in the bloodstream.  

5. Hepatitis B –

A person affected by hepatitis B might have a chance of liver cell damage from the virus. The inflammation of the liver results in scarring, which raises the liver enzymes and starts leaking into the bloodstream. This is due to the immune system starting to detect the virus and special cells fighting with them, which causes inflammation and high enzymes as a defense mechanism.

6. Hepatitis C –

Hepatitis C has also been shown to increase the viral load on the body and elevate the liver’s serum. Mainly, aminotransferase increased clinically. The cause of this is when parenchyma cells get damaged; alanine transferase starts leaking into the blood, which causes increased liver enzymes. 

7. Non-Alcoholic Fatty Liver Disease –

Excessive fat builds up in the liver, which causes damage to the liver cells. These diseases mainly occur in people who do not drink alcohol. It is also denoted by non-alcoholic steatohepatitis. The scarring of the liver means fibrosis is mostly in this type of disease condition. This is irreversible, making it impossible to bring back a healthy liver. ALT and AST are typically seen as elevated non-alcoholic fatty liver disease. 

8. Obesity –

This has been proven that the prevalence of increased liver enzymes is much higher in obese people with normal BMI. As obesity results in inflammation of liver diseases. Additionally, it also alters the metabolism that affects the liver.

9. Alcoholic Hepatitis –

Alcoholic hepatitis causes inflammation of the liver caused by heavy drinking. The alcohol starts producing a toxic substance that triggers liver damage. It leads to an increase in liver enzymes, mainly AST and ALT, causing cirrhosis over time, resulting in lifelong liver damage. 

10. Autoimmune Hepatitis –

Autoimmune hepatitis is related to chronic inflammatory conditions where liver transaminase is elevated in the presence of antibodies. Moreover, there is also an increase in gamma globulin levels. It is when a person’s immune system starts attacking viruses, bacteria, and other pathogens that cause chronic inflammation and severe liver dysfunction, which results in high liver enzymes.

11. Celiac Disease –

The liver enzymes should be checked regularly if a person is affected by celiac disease. This results in a high liver enzyme range which causes extraintestinal symptoms of celiac. However, it returns to normal when a person goes on a gluten-free diet. In addition, liver abnormalities are common if a person suffers from celiac disease. 

12. Cytomegalovirus –

The high liver enzyme is a characteristic feature of cytomegalovirus infection in humans. The cytomegalovirus inflamed the liver and caused high liver enzymes and liver failure. The associated organs also get affected by these conditions, such as the lungs, esophagus, stomach, brain, and sleep.

A few Additional causes of high Liver enzymes are –

• Sepsis
• Polymyositis
• Wilson’s Disease
• Thyroid

What are the high liver enzymes treatments?

You must consult a hepatologist(liver specialist) for immediate treatment if you are diagnosed with a high-level liver enzymes issue.  

High liver enzyme treatment options may vary depending on the causes of high levels of liver enzymes.  

Your doctor may recommend additional tests (Blood, liver function, etc.)and treatments to identify what is causing your increased liver enzymes.

How can you prevent elevated liver enzymes?

There are a couple of ways to decrease the level of enzymes in your body and make your liver healthier. 

• Reduce alcohol intake
• Consume more caffeine
• Taking an organic and natural diet
• Eat fruits and vegetables
• Increase intake of dietary fiber
• Exercise regularly
• Weight reduction
• Quit smoking
• Avoid medication unless prescribed 

Frequently Asked Questions –

Which liver enzymes indicate liver damage? 

The ALP shows the main liver enzymes, which indicate damage. The high ALP damaged hepatic function and may have also blocked the bile duct.  

What are the signs of fatty liver? 

There are a few signs that can indicate fatty liver are: Ascites, Enlarged spleen, Red palms, Yellowing of the skin and eyes.

Can stress cause High liver enzymes?

Yes, excessive stress & anxiety can cause high levels of liver enzymes. 

Outlook – 

Many diseases can severely damage the liver. However, it is crucial to have a health check of your liver function test from time to time. I have listed some causes which everyone should know. There are good doctors who you can visit if you get any abnormalities in your body. The liver is a crucial organ like the heart and brain. Therefore, it is mandatory to follow healthy routines to alleviate the critical liver enzyme value. The high liver enzyme can be resolved in an early stage which is why visiting a liver doctor or a hepatologist can be good for your good health. 

Hepatitis and elevated liver enzymes explained

July 28 is World Hepatitis Day, an occasion to raise awareness about the World Health Organization’s goal to eliminate hepatitis.

But first, we need to understand what triggers the condition. When a doctor uses the term “hepatitis,” it means that there is inflammation in the liver leading to an elevation in liver enzymes. Hepatitis ranges from limited, benign elevations to significant diseases that need to be evaluated and treated. Reshi Kanuru, MD, PPG – Gastroenterology, helps us better understand the disease and its causes.

alcohol and medications as the cause.
Most commonly, elevated liver enzymes are related to excessive alcohol use or the use of certain medications. While it’s likely that a few alcoholic drinks per week won’t cause an elevation in liver enzymes, the amount of alcohol that can cause liver damage varies from person to person. Alcohol consumption in any form can put a strain on the liver, and your doctor can help determine if it’s the cause of your hepatitis. Additionally, numerous medications, such as antibiotics, blood pressure medications, and cholesterol medications can also put a strain on the liver and cause elevations in the enzymes. The good news is that stopping the use of these medications, or stopping the consumption of alcohol, will allow the hepatitis to resolve over time and your enzymes will eventually return to normal.

viral hepatitis.
The next most common cause of liver enzyme elevations is viral hepatitis, such as hepatitis A, B, or C. Of these three types, hepatitis A, which is contracted through contaminated food, is the only one that does not cause long term liver injury. Hepatitis B and C can both lead to long term liver injury and eventually cirrhosis, which is severe scarring of the liver. Currently, hepatitis C is behind most needed liver transplants in the United States. Because hepatitis C is so common and can cause such severe damage, it’s recommended that anyone born between 1945 and 1965 be screened for the disease. It’s important to understand that both hepatitis B and C are treatable.

In the past, hepatitis C was difficult to treat and had poor cure rates partly because of medications that had many intolerable side effects. Recently, however, new medications for hepatitis C have been developed that have few side effects, and boast cure rates above 95 percent after a single course of treatment. Treating everyone for hepatitis C will prevent cirrhosis in millions of Americans and help to significantly reduce healthcare costs in the future.

fatty liver disease.
The epidemic of obesity and the availability of fried foods have led to dramatic health consequences.  Instances of both heart disease and fatty liver disease have been increasing over the last few decades, primarily because of our poor eating habits and overall weight gain.

Fatty liver disease is when fat deposits in the liver and leads to inflammation, which can cause an elevation in liver enzymes. Typically, fatty liver disease occurs in those dealing with obesity who may also have diabetes; however, the disease can also occur in thin individuals who may have genetics that predispose them to liver issues. It’s important to catch fatty liver disease as early as possible, not only because it will soon beat hepatitis C as the most common cause for liver transplantation in the United States, but also because fatty liver disease significantly increases the risk of death due to heart attack and stroke. It can lead to cirrhosis of the liver.

The treatment of fatty liver disease entails eating healthy and committing to 30 minutes of cardiovascular exercise every day with the goal of losing 10 percent of your body weight. Losing weight will cause the amount of fat deposited in the liver to significantly decrease and your risk of heart attack, stroke, and cirrhosis will greatly improve.

autoimmune hepatitis, PBC, PSC and other liver disorders.
Though most people will develop hepatitis related to alcohol, medications, fatty liver and viruses, there are many other diseases that cause elevations in liver enzymes.  Our immune system plays a large role in our health, but unfortunately, the immune system can also cause diseases.

Diseases like autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cholangitis are all autoimmune disorders that affect the liver. It is important to be evaluated for these diseases because they can cause severe liver injury. Beyond autoimmune issues, there are liver diseases that cause abnormal deposition of copper and iron in the liver.  These deposition diseases not only cause liver injury, but can cause damage to multiple organs throughout the body.

causes, symptoms, diagnosis and treatment

Gilbert’s syndrome is a common, harmless liver disease in which the liver does not process bilirubin properly. This is a hereditary genetic disorder. You may not know you have Gilbert’s syndrome until it is discovered by chance, such as when a blood test shows elevated levels of bilirubin. Gilbert’s syndrome does not require treatment.

What is bilirubin?

Definition

Bilirubin is a yellow substance found naturally in the blood. It is formed as a byproduct of the breakdown of old red blood cells. Usually, when red blood cells come to an end (after about 120 days), hemoglobin, the red pigment that carries oxygen in the blood, breaks down into bilirubin. Bilirubin travels through your bloodstream to your liver, where an enzyme breaks down the pigment and removes it from your bloodstream. Bilirubin is also found in bile, a digestive fluid produced by the liver that helps the body metabolize fat. Your liver is part of the digestive system. It filters toxins from the blood, digests fats, and stores glucose as glycogen to use as energy. The liver converts bilirubin to a water-soluble form, which is converted to bile (a fluid produced by the liver to aid digestion) and eventually excreted from the body.

Source: NHS

In Gilbert’s syndrome, bilirubin accumulates in the blood and is slightly higher than normal.

How common is Gilbert’s syndrome?

The modified gene that causes Gilbert’s syndrome is fairly common. Many people carry one copy of this gene. In most cases, Gilbert’s syndrome requires two modified copies to occur.

It is difficult to say exactly how many people are carriers because the syndrome does not always cause obvious symptoms.

3-7% White people

It is difficult to say exactly how many people are carriers because the syndrome does not always cause obvious symptoms. According to various estimates, from 3% to 7% of white people suffer from Gilbert’s syndrome. This type of liver disease is more common in men than women. It affects all ages, races and ethnic groups. Usually the syndrome is diagnosed in a person in late adolescence.

Who can have Gilbert’s syndrome?

Gilbert’s syndrome is genetic, which means that it is passed from parent to child through a change or mutation in the UGT1A1 gene. A healthy gene produces liver enzymes that break down bilirubin and remove it from the body.

UGT1A1

Description

This gene codes for UDP-glucuronosyltransferase, an enzyme in the glucuronidation pathway that converts small lipophilic molecules such as steroids, bilirubin, hormones, and drugs into water-soluble, excreted metabolites. This gene is part of a complex locus encoding several UDP-glucuronosyltransferases. The locus contains thirteen unique alternate first exons followed by four common exons. Four of the alternating first exons are considered pseudogenes. Each of the remaining nine 5′ exons can be spliced ​​to four common exons, resulting in nine proteins with different N-terminals and identical C-terminals. Each first exon encodes a substrate binding site and is regulated by its own promoter. The preferred substrate for this enzyme is bilirubin, although it also has moderate activity against simple phenols, flavones, and C18 steroids. Mutations in this gene result in Crigler-Najjar syndromes types I and II and Gilbert’s syndrome.

Source: RefSeq

When you have the modified gene, your blood contains an excess amount of bilirubin because your body does not produce enough of this enzyme.

Other than inheriting the defective gene, there are no known risk factors for developing Gilbert’s syndrome. It is not related to lifestyle habits, environmental factors, or serious liver problems such as cirrhosis or hepatitis C.

Symptoms of Gilbert’s syndrome

The most common symptom of Gilbert’s syndrome is an occasional yellowish tinge to the skin and whites of the eyes as a result of slightly higher levels of bilirubin in the blood. In people with Gilbert’s syndrome, bilirubin levels may be elevated due to:

Symptom triggers:

1. Illness such as a cold or flu
2. Fasting or very low calorie diet
3. Dehydration
4. Menstruation
5. Strenuous exercise
6. Stress

Most people with Gilbert’s syndrome have occasional and brief episodes of yellowing of the skin and whites of the eyes (jaundice). It is caused by the accumulation of bilirubin in the blood. Jaundice may be less noticeable if you have brown or black skin, but you may notice that the whites of your eyes look yellow.

Since Gilbert’s syndrome usually causes only a slight increase in bilirubin levels, yellowing in jaundice is often mild. The eyes are usually the most affected.

1 in 3

About 1 in 3 people with Gilbert’s syndrome have no symptoms at all. You may not realize you have Gilbert’s syndrome until tests are done for an unrelated problem.

Get tested

See a geneticist if you have had an attack of jaundice for the first time. Jaundice in Gilbert’s syndrome is usually mild, but jaundice may be associated with more serious liver problems such as cirrhosis or hepatitis C.

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If you have been diagnosed with Gilbert’s syndrome, you usually do not need to seek medical attention during an episode of jaundice unless you have additional or unusual symptoms.

Risk factors

Although Gilbert’s syndrome is present from birth, it is usually not noticed until puberty or later because bilirubin production increases during puberty. You are at increased risk of developing Gilbert’s syndrome if:

Factors

1. Both of your parents carry the modified gene that causes this disorder
2. you are a man
3. You have complications
4. You have low levels of the enzyme that converts bilirubin, which causes Gilbert’s syndrome

Diagnosis of Gilbert’s syndrome

Gilbert’s syndrome can be diagnosed with a blood test to measure the level of bilirubin in the blood, a liver function test, and a genetic test.

Bilirubin metabolism

When the liver is damaged, it releases enzymes into the blood. At the same time, the levels of proteins that the liver produces to keep the body healthy begin to decline. By measuring the levels of these enzymes and proteins, one can get a fairly accurate picture of how well the liver is functioning.

If your blood test results show that you have high levels of bilirubin in your blood, but your liver is otherwise functioning normally, we recommend that you have a genetic test to confirm the syndrome.

Living with Gilbert’s syndrome

Gilbert’s syndrome is a lifelong disease. But it does not require treatment because it does not pose a health risk and does not cause complications or an increased risk of liver disease. Episodes of jaundice and any associated symptoms are usually brief and eventually resolve.

Changing your diet or the amount of exercise you do will not change whether you have this disease. But it’s still important to make sure you’re eating a healthy, balanced diet and getting plenty of exercise. You may also find it helpful to avoid things that you know cause jaundice episodes, such as dehydration and stress.

If you have Gilbert’s syndrome, problems with your liver may also mean that you are at risk of developing jaundice or other side effects after taking certain medications, such as high cholesterol medications such as statins.

You should check with your doctor before taking any new medicine. Be sure to tell any doctor treating you for the first time that you have Gilbert’s syndrome.

Gilbert’s syndrome: symptoms, treatment, diagnosis

⁠Hereditary benign liver dysfunction, which leads to an increase in the level of free bilirubin in the blood, is called Gilbert’s syndrome. Many authors of scientific papers do not consider this pathology a disease, characterizing it as a constitutional feature transmitted by heredity. In varying degrees, it occurs in at least 3% of the population, and among the inhabitants of Africa, its prevalence reaches 10%. In men, Gilbert’s syndrome occurs several times more often than in women – according to various estimates, from three to seven times.

General

The main external sign of Gilbert’s syndrome is the characteristic yellowing of the skin, ocular sclera and mucous membranes of the oral cavity. Pathology does not cause structural changes in the liver tissues and is periodic. As a rule, metabolic defects do not manifest themselves before reaching adolescence and are discovered by chance, during an examination conducted for another reason.

A congenital inherited pathology is a decrease in the production of the enzyme glucuronyl transferase in the liver tissues, due to which a certain amount of unbound bilirubin, a breakdown product of hemoglobin, remains in the blood. Exacerbation is usually due to:

• viral or bacterial infection with fever;
• injury or surgery;
• in women – the onset of menstruation;
• violations of the recommended diet, eating foods that create an additional burden on the liver;
• malnutrition or starvation;
• excessive sun exposure;
• lack of sleep;
• severe fluid loss;
• high physical or psychological stress, stress;
• taking certain medications, which include some antibiotics, hormonal drugs, caffeine, etc. ;
• alcohol intoxication.

A distinction is made between the congenital form of Gilbert’s syndrome, which is caused by a defect in the gene of the second chromosome, and the acquired form, which develops after acute hepatitis of viral etiology.

In general, the disease proceeds without serious complications and with a favorable prognosis, although it is accompanied by a decrease in the detoxification function of the liver.

Manifestations of pathology

The latent course is typical for about a third of all cases of the disease. Most often, pathology is detected between the ages of 13 and 30 during an examination conducted for another reason – for example, during a medical examination of young men of military age. With exacerbations of Gilbert’s syndrome, the symptoms depend on the form of the pathology:

• with dyspepsia – with nausea, heartburn, flatulence, metallic taste in the mouth and pain in the right hypochondrium;
• with asthenovegetative – with weakness, headaches, increased sweating, palpitations, sleep disturbances, anxiety, muscle pain;
• with icteric – with a bright icteric coloration of the skin and sclera without changing the color of the discharge;
• with latent – with no external manifestations.

In some patients, there are disorders of the emotional sphere – depressive states, irritability, causeless fears and panic attacks, and in some cases, the tendency to acts of an asocial nature increases. Doctors explain these disorders by self-hypnosis associated with mental stress due to the need to visit doctors, take tests and undergo examinations.

How disease is determined

The most important methods for diagnosing Gilbert’s syndrome are laboratory tests, including:

• general blood and urine tests – increased number of immature erythrocytes and slightly reduced hemoglobin in the blood, bilirubin may be present in the urine;
• biochemical blood test – sugar level may be slightly reduced, protein content is within normal limits, ALT and AST are within normal limits, a negative thymol test result;
• blood test for bilirubin – the total content is increased due to the growth of indirect bilirubin;
• blood clotting test – no deviations;
• analysis for markers of viral hepatitis – negative.
• Serum iron tests and other tests related to blood iron are possible.

In addition, the patient is required to undergo an ultrasound of the liver in order to exclude the possibility of other hepatic pathologies. The size of the liver may increase slightly during periods of exacerbations. Molecular genetic analysis of venous blood is rarely performed due to its high cost, but it allows you to identify defective DNA, which is the cause of Gilbert’s syndrome.

To confirm the diagnosis, stress tests are performed:

• with fasting – with complete starvation or with calorie restriction, the level of free bilirubin increases by 2-3 times;
• with phenobarbital – after a five-day intake, the level of free bilirubin decreases;
• with nicotinic acid – intravenous injection of the drug increases the level of free bilirubin by 2-3 times;
• with rifampicin – the introduction of the drug leads to an increase in the amount of bilirubin.

To exclude chronic hepatitis or cirrhosis, a liver puncture may be prescribed.

How to lower bilirubin?

Since the pathology does not lead to a sharp deterioration in the patient’s condition, the treatment of Gilbert’s syndrome usually comes down to the formation of a lifestyle in which the risk of exacerbation and an increase in the level of bilirubin will be minimized. To do this, the patient should avoid:

• excessive physical activity – sports, heavy physical labor;
• starvation and lack of fluids;
• prolonged sun exposure;
• drinking alcohol;
• taking drugs with toxic side effects on the liver.

Of paramount importance is a special diet for Gilbert’s syndrome, which must be followed throughout life, but most carefully during periods of exacerbations. The diet should be dominated by cereals, mainly buckwheat and oatmeal, vegetable dishes, low-fat or low-fat dairy products, lean meats, poultry and fish. It is advisable to exclude sweets, pastries, chocolate, fatty and spicy dishes from the menu. Portions should be small, the intervals between meals should be reduced.

During exacerbations, courses of vitamin B6 and digestive enzymes may be prescribed, as well as short courses of phenobarbital, a substance that binds free bilirubin.

Frequently Asked Questions

What is the danger of Gilbert’s syndrome?

By itself, Gilbert’s syndrome does not pose a danger to health and well-being. However, with an increase in the level of free bilirubin, bile secretion may gradually decrease, cholelithiasis, cholecystitis or duodenitis may develop.

Why is it impossible to sunbathe with Gilbert’s syndrome?

Due to the negative effect of solar ultraviolet radiation on liver function, sunbathing with Gilbert’s syndrome is undesirable either in the open sun or in a solarium. There is no direct prohibition, but prolonged insolation can activate an increase in unbound bilirubin.