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Does Gilbert's disease exist?

A Bailey, D Robinson, A M Dawson

    Lancet (London, England)
    |April 30, 1977
    PubMed
    Summary
    This summary is machine-generated.

    Serum bilirubin levels in a large screening population suggest that elevated levels, previously diagnosed as Gilbert's disease, may represent the upper limit of normal. This finding supports using the term "constitutional hyperbilirubinaemia" for asymptomatic individuals.

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    Area of Science:

    • Clinical Chemistry
    • Hepatology
    • Public Health Screening

    Background:

    • Elevated serum bilirubin levels are often diagnosed as Gilbert's disease.
    • The classification of Gilbert's disease as a distinct pathological state remains debated.
    • Understanding normal bilirubin distribution is crucial for accurate diagnosis.

    Purpose of the Study:

    • To analyze serum bilirubin concentrations in a large, unselected population.
    • To investigate the distribution of bilirubin levels and assess for bimodality.
    • To re-evaluate the definition and terminology for elevated bilirubin within the normal range.

    Main Methods:

    • Serum bilirubin levels were measured in 18,454 men and 5,471 women attending a screening center.
    • Statistical analysis was performed to examine the distribution of bilirubin concentrations.

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  • The data was assessed for evidence of bimodal distribution, indicative of distinct populations.

    • Main Results:

    • 2.0% of men and 0.6% of women had serum bilirubin concentrations ≥ 25 µmol/L.
    • Bilirubin concentration distributions were skewed in both sexes, but no bimodality was detected.
    • The observed distribution suggests that high-normal bilirubin levels are common.

    Conclusions:

    • The findings challenge the disease classification of Gilbert's disease.
    • Elevated bilirubin in asymptomatic individuals may represent the upper end of the normal physiological range.
    • "Constitutional hyperbilirubinaemia" is proposed as a more appropriate term, emphasizing the benign nature of the condition.