What are the main causes of elevated liver enzymes. How do medications, infections, and lifestyle factors contribute to high liver enzyme counts. When should you be concerned about increased liver enzyme levels.

Understanding Liver Enzymes and Their Significance

Liver enzymes are proteins that catalyze chemical reactions within liver cells. When these enzymes are found in higher-than-normal concentrations in the bloodstream, it often indicates some form of liver cell damage or dysfunction. The most commonly measured liver enzymes include:

• Alanine transaminase (ALT)
• Aspartate transaminase (AST)
• Alkaline phosphatase (ALP)
• Gamma-glutamyl transferase (GGT)

Elevated levels of these enzymes can be detected through routine blood tests and may prompt further investigation into potential liver problems. While a slight increase in liver enzymes doesn’t always indicate a serious condition, persistent or significantly elevated levels warrant medical attention.

Medications as a Common Cause of Elevated Liver Enzymes

Over-the-Counter Pain Medications

Acetaminophen, a widely used over-the-counter pain reliever, can cause liver enzyme elevation when taken in excessive amounts. Why is acetaminophen potentially harmful to the liver? The liver is responsible for metabolizing acetaminophen, and when taken in large doses, it can overwhelm the liver’s capacity to process the drug safely, leading to liver cell damage.

For individuals who consume alcohol regularly, the risk of acetaminophen-induced liver damage is even higher. The combination of alcohol and acetaminophen can result in the accumulation of toxic substances in the body, potentially causing severe liver injury or even liver failure in extreme cases.

Cholesterol-Lowering Medications

Statins, a class of drugs commonly prescribed to lower cholesterol levels, have been associated with mild liver enzyme elevations. While these elevations are often transient and not indicative of significant liver damage, regular monitoring of liver enzymes is recommended for patients taking statin medications.

Should you stop taking your cholesterol medication if you notice elevated liver enzymes? It’s crucial not to discontinue any prescribed medication abruptly without consulting your healthcare provider. In many cases, the benefits of statin therapy outweigh the risks, and your doctor can help determine the best course of action based on your individual health profile.

Infectious Causes of High Liver Enzymes

Viral Hepatitis: A, B, and C

Hepatitis viruses are a significant cause of liver inflammation and elevated liver enzymes. How do these viruses affect liver enzyme levels?

• Hepatitis A: This acute viral infection can cause a sudden increase in liver enzymes, particularly ALT and AST. While hepatitis A typically doesn’t lead to long-term liver damage, it can cause significant short-term elevations in liver enzymes as the body fights off the infection.
• Hepatitis B: Chronic hepatitis B infection can result in ongoing liver cell damage, leading to persistently elevated liver enzymes. The inflammation caused by the virus can lead to scarring of the liver tissue, further contributing to enzyme elevation.
• Hepatitis C: Similar to hepatitis B, chronic hepatitis C infection can cause long-term liver damage and inflammation, resulting in elevated liver enzymes. The virus can lead to increased levels of ALT and AST as liver cells are damaged and release these enzymes into the bloodstream.

Early detection and treatment of viral hepatitis are crucial for preventing long-term liver damage and reducing the risk of complications such as cirrhosis or liver cancer.

Metabolic and Lifestyle-Related Causes of Elevated Liver Enzymes

Non-Alcoholic Fatty Liver Disease (NAFLD)

Non-alcoholic fatty liver disease has become increasingly prevalent in recent years, particularly in developed countries. What causes NAFLD, and how does it affect liver enzymes? NAFLD occurs when excess fat accumulates in the liver cells of individuals who consume little to no alcohol. This condition is often associated with obesity, insulin resistance, and metabolic syndrome.

In NAFLD, the accumulation of fat in liver cells can lead to inflammation and damage, resulting in elevated liver enzymes, particularly ALT and AST. As the disease progresses, it can lead to non-alcoholic steatohepatitis (NASH), a more severe form of fatty liver disease that can cause significant liver damage and fibrosis.

Obesity and Its Impact on Liver Health

Obesity is closely linked to an increased risk of elevated liver enzymes and liver dysfunction. Why are obese individuals more prone to liver enzyme abnormalities? Several factors contribute to this association:

1. Increased inflammation: Obesity is associated with chronic low-grade inflammation throughout the body, including the liver.
2. Insulin resistance: Excess body fat can lead to insulin resistance, which affects liver metabolism and function.
3. Fat accumulation in the liver: Obesity often leads to the deposition of fat in liver cells, contributing to the development of fatty liver disease.
4. Altered metabolism: Obesity can disrupt normal metabolic processes, putting additional stress on the liver.

Weight loss and lifestyle modifications are often recommended as first-line interventions for obese individuals with elevated liver enzymes.

Alcohol-Related Liver Enzyme Elevations

Alcoholic Hepatitis and Chronic Alcohol Abuse

Excessive alcohol consumption is a well-known cause of liver damage and elevated liver enzymes. How does alcohol affect liver enzyme levels? Alcohol can cause liver injury through several mechanisms:

• Direct toxicity: Alcohol and its metabolites can directly damage liver cells.
• Oxidative stress: Alcohol metabolism generates harmful free radicals that can cause cellular damage.
• Inflammation: Chronic alcohol use can lead to persistent liver inflammation.
• Fat accumulation: Alcohol interferes with normal fat metabolism in the liver, leading to fatty liver disease.

In alcoholic hepatitis, liver enzymes, particularly AST and ALT, can be significantly elevated. The ratio of AST to ALT is often higher in alcoholic liver disease compared to other causes of liver injury. Chronic alcohol abuse can lead to cirrhosis, a severe and irreversible form of liver damage characterized by scarring and loss of liver function.

Autoimmune Causes of Elevated Liver Enzymes

Autoimmune Hepatitis

Autoimmune hepatitis is a chronic inflammatory condition in which the body’s immune system mistakenly attacks liver cells. What are the hallmarks of autoimmune hepatitis in terms of liver enzyme elevations? This condition is typically characterized by:

• Elevated liver transaminases (ALT and AST)
• Presence of specific autoantibodies in the blood
• Increased levels of immunoglobulins, particularly IgG
• Evidence of liver inflammation on biopsy

The exact cause of autoimmune hepatitis is unknown, but genetic and environmental factors are thought to play a role. Treatment usually involves immunosuppressive medications to control the immune response and reduce liver inflammation.

Cardiac Conditions and Liver Enzyme Elevations

Heart Failure and Its Impact on Liver Function

Heart failure can have significant effects on liver function and enzyme levels. How does heart failure lead to elevated liver enzymes? The mechanisms include:

1. Reduced hepatic blood flow: Heart failure can result in decreased cardiac output, leading to reduced blood flow to the liver.
2. Hepatic congestion: Increased central venous pressure in heart failure can cause blood to back up in the liver, leading to congestion and potential damage to liver cells.
3. Hypoxia: Reduced blood flow and oxygenation can cause liver cell injury and death.

In heart failure, liver enzymes such as ALT, AST, and ALP may be elevated. The pattern of elevation can sometimes help distinguish between acute liver injury due to shock (characterized by very high ALT and AST) and chronic congestive hepatopathy (where elevations are typically more modest).

When to Seek Medical Attention for Elevated Liver Enzymes

While mildly elevated liver enzymes are not always a cause for immediate concern, certain situations warrant prompt medical evaluation. When should you consult a healthcare provider about elevated liver enzymes?

• Persistent elevations: If liver enzyme levels remain elevated over multiple tests
• Significant elevations: Very high levels of liver enzymes, particularly if accompanied by symptoms
• Symptoms of liver disease: Such as jaundice, abdominal pain, or unexplained weight loss
• Risk factors: If you have known risk factors for liver disease, such as heavy alcohol use or viral hepatitis
• Abnormal imaging results: If liver imaging studies show any concerning findings

A healthcare provider can perform a thorough evaluation, including additional blood tests, imaging studies, and possibly a liver biopsy if necessary, to determine the underlying cause of elevated liver enzymes and develop an appropriate treatment plan.

Understanding the various causes of elevated liver enzymes is crucial for maintaining overall health and detecting potential liver problems early. By recognizing the factors that can contribute to high liver enzyme counts, individuals can take proactive steps to protect their liver health and seek timely medical attention when needed. Regular check-ups and lifestyle modifications can go a long way in preventing and managing liver-related health issues.

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.