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Evaluation of tests for Gilbert's syndrome
Acta Medica Scandinavica
|January 1, 1980
Summary
Caloric restriction effectively increases unconjugated bilirubin in Gilbert's syndrome patients, aiding diagnosis. This method is preferred over nicotinic acid for its higher patient acceptance.
Area of Science:
- Biochemistry
- Clinical Medicine
- Gastroenterology
Background:
- Gilbert's syndrome is a common genetic disorder characterized by elevated unconjugated bilirubin.
- Differentiating Gilbert's syndrome from liver disease can be challenging.
- Biochemical markers are crucial for accurate diagnosis and patient management.
Purpose of the Study:
- To evaluate the diagnostic utility of caloric restriction in differentiating Gilbert's syndrome from liver disease.
- To compare the efficacy of caloric restriction with intravenous nicotinic acid for diagnosing Gilbert's syndrome.
- To explore the role of erythrocyte porphyrin determination in Gilbert's syndrome.
Main Methods:
- Administered a 24-hour caloric restriction (400 kcal) to subjects with Gilbert's syndrome and patients with liver diseases.
- Measured serum total and unconjugated bilirubin levels before and after caloric restriction.
- Administered intravenous nicotinic acid to a subset of Gilbert's syndrome patients for comparison.
- Performed erythrocyte porphyrin determination in a small group of Gilbert's syndrome patients.
Main Results:
- Caloric restriction significantly increased unconjugated bilirubin in Gilbert's syndrome.
- An increase of 15 micromol/l or more in unconjugated bilirubin showed 100% specificity for Gilbert's syndrome.
- Sensitivity for detecting Gilbert's syndrome was approximately 90% in males and 40% in females.
- Intravenous nicotinic acid induced similar bilirubin rises but was less preferred by patients compared to caloric restriction.
- Erythrocyte porphyrin results suggested potential dyserythropoiesis in Gilbert's syndrome.
Conclusions:
- Caloric restriction is a valuable, non-invasive method for supporting the diagnosis of Gilbert's syndrome.
- The 15 micromol/l increase threshold for unconjugated bilirubin offers high specificity.
- Caloric restriction is a well-tolerated and preferred alternative to intravenous nicotinic acid for diagnostic testing in Gilbert's syndrome.