Many people who have Gilbert’s Syndrome (GS) experience itching, which doesn’t seem to be related to any obvious cause and has no visible rash. I myself have been through the obvious checklist many times: washing powder; cosmetics; food; perfume, but nothing had ever changed as, knowing I itch at the drop of a hat, I’m very careful regarding anything I could be allergic to.
BUT…what if it isn’t any kind of allergy?
The idea never occurred to me until Adina let me know that it was a query that had come up several times with Gilbert’s Syndorme sufferers. I have had a look at the information available to the general public and here are some of the interesting facts I found on the subject:-
www.nhsdirect.nhs.uk states that “general itching may be a symptom of many conditions, including…some condition affecting your liver…” The conditions mentioned include more serious liver conditions than GS in terms of prognosis but this doesn’t rule it out as is it not stated that itching is not a GS syptom.
www.netdoctor.co.uk says of primary biliary cirrhosis that the symptoms are identical to any other chronic liver problem – itching aches and low energy. Chronic means long term, Gilbert’s Syndrome is a chronic liver problem, so again, this is indicative that the itching we experience is a symptom of our GS.
I also found some information on the British Liver Trust website (www.britishlivertrust.org.uk) that may explain WHY itching occurs in GS, through an explanation of a different liver condition:-
Itching is stated as a symptom of cholestasis, which is a reduction in the flow of bile from the liver. This causes bile salts to build up in the blood, be deposited in the skin and cause itching. Bilirubin increases are suggestive of problems with the bile duct. Gilbert’s Syndrome is diagnosed due to a long term increase in bilirubin, also classified as ‘bile level’ in blood tests of liver function.
In Gilbert’s Syndrome bilirubin is raised due to lack of an enzyme rather than a blockage of the bile duct. It was not clear to me from the information I had found so far if an increase in bilirubin goes hand in hand with an increase in bile salts or whether the two are mutually exclusive. So I read further…
I found quite a lot of work which links bilirubin and bile salts, for example www.revision-notes.co.uk/revision/859.html , in describing the process of bile secretion, states of bile “It is an alkaline, mucous fluid containing bile pigments, biliverdine and bilirubin. Bile also contains bile salts…”
However, I have not been able to find anything that specifically states that bile salt levels are raised in Gilbert’s Syndrome or whether bilirubin can be increased without bile salts being raised. It is always stated that of all liver function tests only bilirubin is rasied in GS which suggests levels of bile salts are normal, although I do not know if this is tested separately. If this is the case it is possible that bile salts may fluctuate, even if within normal limits at testing, causing itching on occasion but not constantly. This is pure speculation but I hope gives us something to think about and ask our GPs next time we have a consultation.
By contributor Nicola Southworth