Gilbert's Syndrome Treatment Philadelphia PA

Should you worry about your GS? In Gilbert’s syndrome (GS), your liver loses some of its ability to eliminate bilirubin—a yellow pigment that results from the breakdown of red blood cells.

Kashyap V Panganamamula, MD
(215) 707-4546
3401 N Broad St
Philadelphia, PA
Specialties
Gastroenterology
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Graduation Year: 2007

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Jvothi Mekapati, MD
(215) 707-3433
3401 N Broad St
Philadelphia, PA
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Gastroenterology
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Brenda Lapinski Horwitz, MD
(215) 707-3431
3401 N Broad St
Philadelphia, PA
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Medical School: Jefferson Med Coll-Thos Jefferson Univ, Philadelphia Pa 19107
Graduation Year: 1987

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Joyann Kroser, MD
(215) 762-6220
Mail Stop 913 5th Floor 219 N Broad Street
Philadelphia, PA
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Gastroenterology
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Graduation Year: 2007

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Robert Stephen Fisher, MD
(215) 707-3433
3401 N Broad St
Philadelphia, PA
Specialties
Gastroenterology, Internal Medicine
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Medical School: Univ Of Pa Sch Of Med, Philadelphia Pa 19104
Graduation Year: 1964
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Hospital: Temple University Hospital, Philadelphia, Pa
Group Practice: Temple University Hospital

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Steven Davidoff, MD
(215) 587-9853
3401 N Broad St
Philadelphia, PA
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Medical School: Va Commonwealth Univ, Med Coll Of Va Sch Of Med, Richmond Va 23298
Graduation Year: 1974

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Marianne Theresa Ritchie
(215) 707-9900
3401 N Broad St
Philadelphia, PA
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Gastroenterology, Internal Medicine

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Marianne T Ritchie, MD
(610) 896-7360
3401 N Broad St Fl 8
Philadelphia, PA
Specialties
Gastroenterology
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Female
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Medical School: Jefferson Med Coll-Thos Jefferson Univ, Philadelphia Pa 19107
Graduation Year: 1980

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Barry Levitt, MD
(215) 707-3433
3401 N Broad St
Philadelphia, PA
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Gastroenterology
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Male
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Graduation Year: 2007

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Harvey Michael Licht, MD
(215) 842-6511
3401 N Broad St
Philadelphia, PA
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Gastroenterology
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Medical School: A Einstein Coll Of Med Of Yeshiva Univ, Bronx Ny 10461
Graduation Year: 1975

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Ask the Doctor—Living with Gilbert's Syndrome

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By Robert Rountree, MD

Q After finding elevated bilirubin on a routine blood test, my doctor told me I had Gilbert’s syndrome, but it was nothing to worry about. Is that really true?

In Gilbert’s syndrome (GS), your liver loses some of its ability to eliminate bilirubin—a yellow pigment that results from the breakdown of red blood cells. A relatively common genetic condition, GS may affect as much as 10 to 20 percent of the population. Under normal conditions, the liver detoxifies bilirubin by combining it with a type of sugar called glucuronic acid in a process known as conjugation. The liver then releases the “conjugated” bilirubin into the bile ducts from whence it subsequently gets eliminated in the stool. For people with GS, the UGT1A1 enzyme that conjugates bilirubin works at only 20 to 70 percent of normal.

In a person with GS, situations that either increase the breakdown of red blood cells or overload the detoxifying ability of the liver can cause blood levels of “unconjugated” bilirubin to rise so high that the whites of her eyes will turn yellow—a condition called jaundice. This can occur with fasting, prolonged strenuous exercise, fatigue, surgery, infections, excessive alcohol intake, or menstruation.

Up until a few years ago, experts considered GS an innocuous condition, the only significant feature of which was abnormally high levels of unconjugated bilirubin on routine fasting blood tests. As it turns out, GS is not so benign: A significant percentage of people with this genetic abnormality also have an impaired ability to metabolize and excrete certain medications, including the pain-relieving drug acetaminophen (Tylenol) and a cancer chemotherapy agent called irinotecan. That makes them more susceptible to side effects, such as liver toxicity from acetaminophen or a severe drop in white blood cells from irinotecan. More recently, a groundbreaking study at the University of Washington in Seattle has shown that having a sluggish UGT1A1 enzyme can make it more difficult for people with the most severe form of GS to eliminate cancer-causing environmental toxins found in smoke, automotive exhaust, and charbroiled meat.

The study also reports another significant discovery, however: Eating a diet rich in cruciferous vegetables like broccoli, Brussels sprouts, cabbage and watercress can increase the activity of the UGT1A1 enyzme. (Onions, citrus fruits, and legumes also increase activity of the UGT1A1 enzyme, but not quite at the level as crucifers.) This implies that people with GS are particularly susceptible to the beneficial, cancer-preventive properties of broccoli and its edible relatives. Based on this research, I would recommend that you minimize the use of acetaminophen and avoid grilled meats, cigarette smoke, and exhaust fumes from petrochemical fuels as much as possible. In addition, eat at least one full serving of cruciferous vegetables every day. Or, if you aren’t particularly fond of this vegetable family, tr...

Author: Robert Rountree, MD

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