Incidence and Risk of Gallstone Disease in Gilbert's Syndrome Patients in Indian Population

Abstract

Individuals with Gilbert's syndrome (GS) harbor mutations in the UGT1A1 gene and are known to have elevated levels of bilirubin, which enhances the risk for gall stone formation. The aim of this study is to screen Indian patients with GS for the incidence of gall stone disease. Individuals with persistently elevated serum bilirubin levels were genotyped for two polymorphisms (rs8175347; rs4148323) in UGT1A1 gene to confirm GS in them. Flanking regions of the above polymorphisms were amplified followed by direct sequencing. Ultrasonography was done to detect gallstone disease. Clinical data, including assessment of liver function, circulating levels of total and direct bilirubin, as well as routine hematological parameters were obtained as per standard procedures (Autoanalyzer). Of the total 1621 individuals subjected to genotyping, 1191 (1149 males of 29.6±11.3 years with mean BMI of 22.1±3.7kg/m2 and 42 females of 30.8±14.8 years with mean BMI of 20.9±3.7kg/m2) were confirmed to have GS. Gall bladder abnormalities including cholelithiasis (n=106/1191; 8.9%), polyps (n=18/1191; 1.5%) and gallbladder wall thickening (n=17/1191; 1.4%) were noted. Incidence of gall stone disease was observed in 103 males (out of 1149) and 3 females (out of 42) indicating the risk of the disease to be 9.0% and 7.1% respectively in males and females with GS. Early recognition of GS by genetic analysis is required before these patients with intermittent episodes of jaundice run the risk of unnecessary operations on their bile ducts from the mistaken assumption ascribing the jaundice to a stone which has been left behind.