MEASUREMENT OF UNCONJUGATED HYPERBILIRUBINEMIA IN GILBERT'S SYNDROME DURING COMPULSORY FASTING

Yıl 1999, Cilt: 12 Sayı: 4, 171 - 174, 03.12.2016

Sail Kapıcıoğlu Mustafa Çetiner Abdulhalim Baki

Öz

Objective: We investigated the effect of compulsory fasting on unconjugated hyperbilirubinemia in ten adult patients with Gilbert's syndrome during Ramadan (a fasting period of 30 days).
Methods: At 4 a.m. and 8 p.m. they were given meals which contained a total of approximately 2500 cal. After the 4 a.m. baseline measurement was taken, the patients did not eat or drink anything for 16 hr for religious reasons. The serum total and indirect bilirubin concentrations were measured every week during this 4 week period of compulsory fasting.
Results: Prefasting basal mean serum bilirubin concentrations were: total bilirubin 1.4±0.06 mg/dl, conjugated bilirubin 0.4±0.03 mg/dl, unconjugated bilirubin 1.0±0.05 mg/dl. On the first day after a 16 h fasting the values were: total bilirubin 2.6±0.06 mg/dl, conjugated bilirubin 0.4±0.03 mg/dl and unconjugated bilirubin 2.110.12 mg/dl. In this period, conjugated bilirubin remained unchanged while total and unconjugated bilirubin significantly increased compared to the basal value (p<0.013). On the 7th, 14th, and 30th day of fasting the serum total and unconjugated bilirubin decreased to basal value. The mean total bilirubin level was 1.410.04 mg/dl, 1.410.11 mg/dl and 1.310.06 mg/dl on the 7th, 14th and 30th day respectively. The mean unconjugated bilirubin level was 0.910.04 mg/dl, 0.910.09 mg/dl and
0.810.09 mg/dl respectively.
Conclusion: Compulsory fasting during Ramadan (a period of 30 days) resulted in an increase in plasma unconjugated bilirubin concentrations on the first day of fasting. Then it decreased to basal value on the 7th, 14th and 30th day in patients with Gilbert's syndrome. It is assumed that these results may be important in diagnosing Gilbert's syndrome and its clinical features in the Muslim population.
Key Words: Unconjugated hyperbilirubinemia, Gilbert's syndrome, Compulsory fasting

Kaynakça

• Arias IM. Chronic unconjugated hyperbilirubinemia without overt signs of hemolysis in adolescents and adults. J Clin Invest 1962;41:2233-2245.
• Black M, Billing Bfl. Hepatic bilirubin UDP-glucuronyl transferase activity in liver disease and Gilberts syndrome. H Engl J Med 1969;280:1266-1270.
• Flesher BF, Craig JR. Carpio H. Hepatic bilirubin giucuronidation in Gilberts syndrome. J Lab Clin Fled 1973;81:829-837.
• Okolicsanyi L, Fevery J, Billing B et al. How should mild, isolated unconjugated hyperbilirubinemia be investigated? Semin Liver Dis 1983;3:36-41.
• Billing BH, Williams R, Richards TG. Defects in hepatic transport of bilirubin in congenital hyperbilirubinemia. An analysis of plasma bilirubin disappearance curves. Clin Sei 1967;27:245-257.
• Okolicsanyi L, Ghidini O, Orlando R, et al. An evaluation of bilirubin kinetics with respect to the diagnosis of Gilberts syndrome. Clin Sei Idol Med 1978;54:539-547.
• Berk PD, Bloomer JR, Howe RB, Berlin HI. Constitutional hepatic dysfunction (Gilberts syndrome): A new definition based on kinetic studies with uncunjugated radiobilirubin. Am J Med 1970;49:296-305.
• Berk PD, Jones EA, Howe RB. Disorders of bilirubin metabolism. In: Bondy PR, Rosenberg LE, eds: Metabolic Control and Disease. 8th ed. Philadelphia, WB Saunders, 1980:1009-1088.
• Berk PD, Berman MD, Blitzer BL. Effect of splenectomy on hepatic bilirubin clearance in patients with hereditary spherocytosis. J Lab Clin Med 1969;98:37-45.
• Black M, Billing BH. Hepatic bilirubin UDP glucuronyl transferase activity in liver disease and Gilbert s syndrome. H Engl J Med 1969:280:1266- 1271.
• Okolicsanyi L, Frei J, Magnenat P, Haccarato R. Multiplicity and specifity of UDP-glucronyl- transferase 111. UDP-glucuronyltransferase and B- glucuronidase activities assayed with different substrates in inherited and acquired human liver disease. Enzyme 1971;12:658-673.
• Felsher BF, Richard D, Redeker AG. The reciprocal relation between caloric intake and the degree of hyperbilirubinemia in Gilberts syndrome. H Engl J Med 19 70:283: l 70-1 72.
• Owens D, Sherlock S. Diagnosis of Gilberts syndrome. Role of reduced caloric intake. Br Med J 1973;3:559-563.
• Whitmer DL Gollan IL. Mechanisms and significance of fasting and dietary hyperbilirubinemia. Semin Liver Dis 1983;3:42-45.
• Davidson AR. Rojas-Bueno A, Thompson RPH, Williams R. Reduced caloric intake and nicotinic acid provocation test in the diagnosis of Gilberts syndrome. Br Med J 1975;2:480-485.
• Rollinghoff W, Paumgartner G, Preising R. nicotinic acid test in the diagnosis of Gilbert's syndrome- correlation with bilirubin clearance. Gut 1981;22:663-668.
• 7. Mallory fl, Evelyn K. The determination of bilirubin with the photoelectric calorimeter. J Biol Chem 1937,119:481-490.
• With TK. Bile Pigments: chemical, biological and clinical aspects, new York, Academic Press. 1968:411.
• Bradley EM, Bellamy ITM, Khudsen KB, Lacocg FR. Impairment of biliary transport as a cause of
• sulfobromophthalein retention in fasting men. Metabolism 1969,18:675-683.
• Felsher BP, Carpio nM. Caloric intake and unconjugated hyperbilirubinemia Gastroenterology 1975;69:42-47.
• Feulk WT, Butt flR, Owen CA. Constitutional hepatic dysfunction (Gilberts disease): its natural history and related syndrome. Medicine Balt 1959;38:25-
• Bloomer JR, Barrett PV, Rodkey PL, Berlin ni.
• Studies on the mechanism of fasting
• hyperbilirubinemia. Gastroenterology 1971 ;61:479- 487.