Indian Journal of Medical Biochemistry

Register      Login

VOLUME 23 , ISSUE 3 ( September-December, 2019 ) > List of Articles


Gilbert's Syndrome after Ritualistic Prolonged Fasting of Chhath Puja in Bihar, India: A Case Report and Literature Review

Hemant K Sharma, Shivani Prashar

Keywords : Bilirubin, Gilbert's syndrome, Hemolysis, Hyperbilirubinemia

Citation Information : Sharma HK, Prashar S. Gilbert's Syndrome after Ritualistic Prolonged Fasting of Chhath Puja in Bihar, India: A Case Report and Literature Review. Indian J Med Biochem 2019; 23 (3):354-356.

DOI: 10.5005/jp-journals-10054-0127

License: CC BY-NC 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Gilbert' syndrome (GS), most common hereditary cause of unconjugated hyperbilirubinemia due to polymorphisms in uridine diphosphate glucuronosyltransferase (UGT) enzyme, was first described by Augustin Nicolas Gilbert and Pierre Lereboullet in 1901. It becomes apparent around adolescence and often precipitated by prolonged fasting, intercurrent illness, or strenuous exercise. Gilbert's syndrome has an excellent prognosis and does not require any treatment. But recent studies have shown that patients with GS are more susceptible to enhanced toxicity of several drugs using UGT enzyme in their metabolism. Also, hyperbilirubinemia is protective due to its anti-inflammatory, anti-oxidant, and anti-cancer properties, particularly in colon cancer. In India, followers of different religious practice a ritualistic prolonged fastings, which can predispose susceptible cases of GS to unconjugated hyperbilirubinemia. We report a rare case of GS unmasked by ritualistic prolonged fasting of Chhath Puja in Bihar to increase awareness about it among medical fraternity and patients.

  1. Bosma PJ. Inherited disorder of bilirubin metabolism. J Hepatol 2003;38(1):107–117. DOI: 10.1016/S0168-8278(02)00359-8.
  2. Manandhar SR, Gurubacharya RL, Baral MR, et al. A case report of Gilbert syndrome. Kathmandu Univ Med J (KUMJ) 2003;1(3): 187–189.
  3. Jiraskova A, Novotny J, Novotny L, et al. Association of serum bilirubin and promoter variations in HMOX1 and UGT1A1 genes with sporadic colorectal cancer. Int J Cancer 2012;131(7):1549–1555. DOI: 10.1002/ijc.27412.
  4. Farheen S, Sengupta S, Santra A, et al. Gilbert's syndrome: high frequency of the (TA)7TAA allele in India and its interaction with a novel CAT insertion in promoter of the gene for bilirubin UDP-glucuronosyltransferase 1 gene. World J Gastroenterol 2006;12(14):2269–2275. DOI: 10.3748/wjg.v12.i14.2269.
  5. Wazib A, Hossain MZ, Saha JK, et al. A case of Gilbert's syndrome. J Dhaka Med Coll 2010;19(1):67–68. DOI: 10.3329/jdmc.v19i1.6257.
  6. Zelenka J, Dvolak A, Alan L, et al. Hyperbilirubinemia protects against aging-associated inflammation and metabolic seterioration. Oxid Med Cell Longev 2016;2016:6190609. DOI: 10.1155/2016/6190609.
  7. Fevery J. Bilirubin in clinical practice: a review. Liver Int 2008;28(5): 592–605. DOI: 10.1111/j.1478-3231.2008.01716.x.
  8. Bosma PJ, Chowdhury JR, Bakker C, et al. The genetic basis of the reduced expression of bilirubin UDP-glucuronosyltransferase 1 in Gilbert's syndrome. N Engl J Med 1995;333(18):1171–1175. DOI: 10.1056/NEJM199511023331802.
  9. Lee JH, Moon KR. Coexistence of Gilbert syndrome and hereditary spherocytosis in a child presenting with extreme jaundice. Pediatr Gastroenterol Hepatol Nutr 2014;17(4):266–269. DOI: 10.5223/pghn.2014.17.4.266.
  10. Mousavi S, Malek M, Babaei M. Role of overnight rifampin test in diagnosing Gilbert's syndrome. Indian J Gastroenterol 2005;24(3):108–110.
  11. Kotal P, Vitek L, Fevery J. Fasting-related hyperbilirubinemia in rats: the effect of decreased intestinal motility. Gastroenterology 1996;111(1):217–223. DOI: 10.1053/gast.1996.v111.pm8698202.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.