Gilbert-Meulengracht disease, or Gilbert syndrome, is a metabolic disorder that is manifested by elevated levels of bilirubin in the blood. The disorder is genetic but very rarely results in permanent damage.
What is Gilbert-Meulengracht disease?
Infographic on the anatomy and structure of the liver. Click to enlarge. Meulengracht disease is the term used to describe an effect characterized by an increased concentration of indirect bilirubin in the blood. This results in various symptoms such as yellowing of the eyes. Since indirect bilirubin is poorly soluble in water, it binds to albumins, which act as solubilizers. Gilbert-Meulengracht disease is thus a metabolic disorder. It results from delayed biochemical conversion processes in the blood and is completely harmless. However, various symptoms develop that can be treated.
Causes
Meulengracht’s disease is caused by a decrease in the activity of the enzyme UDP-glucuronosyltransferase. This enzyme is responsible for converting fat-soluble metabolites into water-soluble end products. If this process is disturbed, various metabolic products and exogenous substances such as drugs cannot be optimally prepared for excretion from the body. This results in the symptoms mentioned above. In particular, the red blood pigment heme is disturbed. The effect, which is triggered in particular by reduced activity of the enzyme UDP-glucuronosyltransferase, rarely has external causes. However, a low-fat diet can trigger the manageable symptoms. Fasting diets are also frequently associated with Gilbert-Meulengracht disease.
Symptoms, complaints, and signs
Gilbert-Meulengracht disease is usually completely harmless. In the vast majority of cases, there are no symptoms at all. Only yellowing of the white portions of the eyeball and, in very rare cases, of the skin is observed under certain conditions. The yellowing is caused by an increased concentration of bilirubin in the blood, which results from the slowed breakdown of bilirubin. Because increased bilirubin is formed during exercise, alcohol consumption, low-fat diets, or prolonged periods of fasting, the discoloration of sclerae and skin also increases under these conditions. However, these are usually the only symptoms of Gilbert-Meulengracht disease. Itching, as in jaundice associated with liver disease, does not occur here. Rarely, however, jaundice may be accompanied by uncharacteristic symptoms such as fatigue, abdominal pain with nausea, migraine-like headache, loss of appetite, and irritability. However, these symptoms are not dependent on the level of bilirubin concentration. It is also characteristic of Gilbert-Meulengracht disease that it usually affects only young men after puberty. Gilbert-Meulengracht disease does not have any disease value. Complications do not occur. The eye and skin discolorations become less frequent with age until they often disappear completely in old age. In rare cases, however, the accompanying symptoms have a detrimental effect on the quality of life. The first appearance of yellowing of the eyes and skin can also be disconcerting for those affected until they are educated about the harmlessness of the condition.
Diagnosis and course
Gilbert-Meulengracht disease can be diagnosed unequivocally. For this purpose, it is necessary to determine in conversation with the affected person which symptoms occur. If it turns out that there is increased nausea in conjunction with yellow eyes, there may at least be a suspicion. Other symptoms occur at most in connection with infections. Thus, the syndrome may be accompanied by complaints in the area of the liver, nausea and malaise. Especially during fasting or stress, the symptoms are intensified. Beyond that, however, the effect has no significant symptoms and usually remains without health complications for those affected. Therefore, it is difficult to detect Meulengracht’s disease by external examination. A blood test, on the other hand, can quickly provide information about the syndrome. In particular, the bilirubin values are crucial. If only these values are elevated and all other blood values are at a normal level, it can be assumed that the patient has Gilber-Meulengracht disease. Although the syndrome is harmless, the diagnosis is nevertheless of crucial importance.Thus, serious diseases of the liver can be ruled out by it. Hemolysis can also be ruled out with a clear diagnosis. In some cases, doctors therefore resort to a genetic test to be one hundred percent certain. The course of Gilbert’s syndrome is unproblematic. In most cases, symptoms such as yellow eyes and nausea disappear after a few days. Even during longer fasting cures, the syndrome rarely leads to health restrictions. Meulengracht’s disease is often not noticed at all by those affected. Nevertheless, the symptoms should not be underestimated. It could be a serious disease of the liver, which must be treated in any case.
Complications
In most cases, Gilbert-Meulengracht disease does not cause any particular limitations or complications. Most patients live with the disease their entire lives, and there is no reduction in life expectancy. Therefore, the disease does not need to be treated if no symptoms occur. However, if symptoms do occur, they are usually manifested by fatigue and exhaustion of the patient. The resilience of the affected person also decreases significantly due to Gilbert-Meuleng’s disease and it can lead to impairments in everyday life. Furthermore, some affected persons suffer from nausea and yellow eyes. If the symptoms of the liver are severe, the patient may feel very unwell. Complications can arise from Gilbert-Meulengracht disease if the affected person fasts, as the symptoms are further exacerbated in this case. As a rule, Gilbert-Meulengracht disease does not require treatment. Only in cases of severe symptoms can the symptoms be limited. The patient’s life expectancy is not reduced by the disease and no further complications occur.
When should you see a doctor?
Nonhemolytic icterus, a metabolic disorder known as Gilbert-Meulengracht disease, is already congenital. The symptoms that occur with it are noticed relatively quickly because they are associated with signs of jaundice. The first visit to the doctor therefore usually occurs early in life, often during puberty. In the absence of liver damage, an adjusted diet is usually sufficient. The symptoms that the genetic defect can cause depend on several factors. Most of them can be influenced by the affected person himself through dietary adjustments. In this respect, those affected by Gilbert-Meulengracht disease have it in their own hands to remain virtually symptom-free by adopting an appropriate lifestyle. It should be noted, however, that certain medications for other diseases or pain can aggravate the symptoms of Gilbert-Meulengracht disease. Therefore, when taking cholesterol-lowering drugs such as simvastatin or atorvastatin, a physician should be consulted for monitoring purposes. The same is recommended for the use of estrogen-containing contraceptives such as the birth control pill or much-used over-the-counter pain relievers such as acetaminophen or ibuprofen. If the eyes turn yellow, a doctor should be visited in any case. Jaundice or liver disorder must be ruled out. The presence of Gilbert-Meulengracht disease only requires abstaining from fasting cures and certain stimulants such as alcohol or nicotine. Doctor’s visits are usually not necessary because of this.
Treatment and therapy
Meulengracht’s disease is a harmless metabolic disorder and accordingly does not require mandatory treatment. However, it is possible to remedy the symptoms and provide education. This is especially necessary if the affected person is distressed by yellow eyes or repeated nausea and thus experiences a reduced quality of life. Therefore, the most important pillar of treatment is a detailed discussion with the affected person. In this, the individual symptoms can be discussed and attributed to the high bilirubin levels. Another pillar of treatment is testing for incompatible medications. Certain drugs in particular, such as paracetamol, can aggravate the symptoms and should be discontinued under certain circumstances. It can therefore be said that Meulengracht’s disease does not normally cause any problems. At most, the uncertainty of those affected must be dispelled through education. In general, it is questionable whether Meulengracht’s disease is a disease at all.For example, recent studies have shown that Gilber’s syndrome can prevent colon cancer, atherosclerosis, and lung disease.
Outlook and prognosis
The prognosis for Gilbert-Meulengracht disease is very good for patients. Life expectancy for affected individuals is also as high as life expectancy for unaffected individuals. Moreover, Gilbert-Meulengracht disease is completely harmless in most of the cases that occur. Only extremely rarely do the symptoms of the disease affect those affected. However, the older the affected person, the less frequent and milder the symptoms of the disease become. In a large number of cases, the symptoms even disappear completely at an advanced age. It is assumed that the mortality of those affected is not increased by the disease. There are even studies that indicate that the increased bilirubin level due to the disease protects against certain diseases of the lungs and thus reduces the general mortality. Above all, this concerns protection against chronic obstructive pulmonary disease and also against the dreaded lung cancer. However, the cosmetic problem of yellowing of the eyes, which can occur in those affected, is often a very high burden. Often outsiders cannot interpret the yellowing correctly and think of contagious diseases. In such cases, the conversation with a doctor should be sought to discuss possible treatment options. In general, however, a therapy of the disease Gilbert-Meulengracht is not necessary.
Prevention
Gilbert-Meulengracht disease has no disease value and therefore does not require preventive treatment. If one wishes to avoid the characteristic yellowing of the eyes, it is recommended that fasting diets and low-fat diets be avoided as much as possible. This should keep bilirubin levels at a normal level. In addition, with the syndrome, it is important to provide education. If other people suffer from the symptoms, Gilbert-Meulengracht disease should be pointed out as the cause. Medications should only be taken after consultation with a physician. Despite the harmless symptoms, a comprehensive diagnosis should be made for yellow eyes. It is not uncommon for it to be a disease of some other kind.
What you can do yourself
As a rule, Gilbert-Meulengracht disease is harmless. Treatment is neither possible nor necessary. However, it is recommended for those affected to inform themselves in detail about the disease. Especially on the Internet, a lot of information can be found on how to deal with the disease and how to avoid symptoms. In the case of Gilbert-Meulengracht disease, there is only an indirect health risk if those affected take certain medications and these can be broken down more poorly by the body. In a few cases, this can lead to mild side effects. Such symptoms are particularly known when taking cancer and HIV medications. To clarify tolerability, it is advisable to study the package insert before taking new medications. In general, patients should try to spare the liver as much as possible. For this reason, they should avoid nicotine and alcohol as far as possible. It is also particularly important that those affected should not consume any drugs. In general, a healthy, balanced diet is advisable. To be on the safe side, it is advisable to consume dietary supplements, foods with chemical additives, Ayurvedic teas, Chinese herbs as well as herbal preparations only in smaller doses. Sufferers should avoid hunger pangs as a matter of principle. Planned diets and excessive starvation diets must be discussed with a doctor. In addition, sufferers are advised to get enough sleep.
