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Chronic persistent hepatitis and unconjugated hyperbilirubinemia.

B F Felsher, N M Carpio

Gastroenterology

|February 1, 1979

Summary

Chronic persistent hepatitis is linked to reduced hepatic bilirubin UDP-glucuronyltransferase activity, causing unconjugated hyperbilirubinemia. This acquired enzyme defect, distinct from Gilbert's syndrome, is likely related to the hepatitis itself.

Area of Science:

Hepatology
Biochemistry
Gastroenterology

Background:

Unconjugated hyperbilirubinemia can occur in patients with chronic persistent hepatitis.
The exact cause of this condition in hepatitis patients is not fully understood.

Purpose of the Study:

To investigate the activity of hepatic bilirubin UDP-glucuronyltransferase (UGT1A1) in patients with chronic persistent hepatitis and unconjugated hyperbilirubinemia.
To compare enzyme activity in these patients with normal individuals and those with Gilbert's syndrome.

Main Methods:

Assayed hepatic bilirubin UDP-glucuronyltransferase activity in 12 patients with chronic persistent hepatitis and mild unconjugated hyperbilirubinemia.
Compared patient enzyme activity to data from normal subjects, patients with acute hepatitis, and patients with Gilbert's syndrome.

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Examined the incidence of hyperbilirubinemia in first-degree relatives.

Main Results:

Hepatic bilirubin UDP-glucuronyltransferase activity was significantly lower in patients with chronic persistent hepatitis compared to normal individuals.
Enzyme activity in chronic persistent hepatitis patients was higher than in patients with Gilbert's syndrome.
The incidence of hyperbilirubinemia in relatives was lower in chronic persistent hepatitis patients than in Gilbert's syndrome patients.

Conclusions:

The unconjugated hyperbilirubinemia associated with chronic persistent hepatitis is likely caused by an acquired decrease in hepatic bilirubin UDP-glucuronyltransferase activity.
This enzyme defect appears to be related to the presence of chronic persistent hepatitis.
The findings differentiate the mechanism from that of Gilbert's syndrome.