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Gilbert syndrome

Last reviewed: 12 Sep 2025
Last updated: 10 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • postpubertal age
  • positive family history of GS
  • icterus (jaundice)
  • absence of hepatosplenomegaly
  • no stigmata of chronic liver disease
Full details

Risk factors

  • postpubertal age
  • family history of GS
  • type 1 diabetes mellitus
Full details

Diagnostic investigations

1st investigations to order

  • unconjugated bilirubin
  • liver aminotransferases
  • gamma-glutamyl transpeptidase
  • lactate dehydrogenase
  • CBC
  • peripheral blood smear
  • direct Coombs' test
Full details

Investigations to consider

  • liver biopsy
  • plasma unconjugated bilirubin response to fasting
  • plasma unconjugated bilirubin response to nicotinic acid
  • UGT1A1 genotyping
  • UDPGT enzyme activity
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Nathalie Khoury, MD

Clinical Fellow - Transplant Hepatology

University of Nebraska Medical Center

Omaha

NE

Disclosures

NK declares that she has no competing interests.

Marco A. Olivera-Martinez, MD, FACP, FAASLD

Professor of Medicine

Gastroenterology & Hepatology

University of Nebraska Medical Center

Omaha

NE

Disclosures

MAOM declares that he has no competing interests.

Acknowledgements

Dr Marco A. Olivera-Martinez would like to gratefully acknowledge Dr Brian Ward and Dr John L. Gollan, the previous contributors to this topic.

Disclosures

BW declares that he has no competing interests. JLG is an author of a reference cited in the topic.

Revisores

Lefkothea P. Karaviti, MD, PhD

Professor of Pediatrics

Division of Endocrinology and Metabolism

Baylor College of Medicine

Texas Children's Hospital

Houston

TX

Declarações

LPK declares that she has no competing interests.

John T. Jenkins, MB, CHB, FRCP

Consultant Surgeon

St. Mark's Hospital

London

UK

Declarações

JTJ declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Bosma PJ, Chowdhury JR, Bakker C, et al. The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert's syndrome. N Engl J Med. 1995 Nov 2;333(18):1171-5.Texto completo  Resumo

King D, Armstrong MJ. Overview of Gilbert's syndrome. Drug Ther Bull. 2019 Feb;57(2):27-31. Resumo

Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017 Jan;112(1):18-35.Texto completo  Resumo

Artigos de referência

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