When should I consider referring a patient with suspected Gilbert's Syndrome for further investigation?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

You should consider referring a patient with suspected Gilbert's syndrome for further investigation if there are any features that suggest a more serious underlying cause, as jaundice is usually indicative of serious illness requiring urgent investigation and treatment . While Gilbert's syndrome can be diagnosed and managed in primary care for well individuals ,, referral is essential in many circumstances.

Consider immediate referral or same-day secondary care assessment if the patient with jaundice:

  • Is exhibiting red flag signs and symptoms .
  • Has a bilirubin level greater than 100 micromol/L .
  • Has an abnormal clotting profile or shows signs of coagulopathy .
  • Has abnormal renal function .
  • Is frail or has significant co-morbidities .

Additionally, refer for further investigation if:

  • The patient is aged 40 years and over, using a suspected cancer pathway referral (for an appointment within 2 weeks) to exclude pancreatic cancer ,.
  • There is a cholestatic or obstructive picture on liver function tests (LFTs), requiring referral to an upper gastrointestinal surgeon, gastroenterologist, or liver clinic .
  • There is a hepatitic picture on LFTs, requiring urgent referral to a liver clinic or gastroenterologist .
  • The episode of jaundice is more severe or persistent than usual, as this may indicate an alternative diagnosis that could co-exist with Gilbert's syndrome .
  • The jaundice is unexplained .

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Educational content only. Always verify information and use clinical judgement.