{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T18:05:19Z","timestamp":1765649119040,"version":"3.48.0"},"reference-count":33,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1974,2]]},"abstract":"<jats:p>Moderate unconjugated hyperbilirubinaemia decreasing after pneumatic dilatation of the gastrooesophageal sphincter, so permitting a normal amount of food to be taken was observed in two patients with achalasia. Liver biopsy was performed, and hepatic digitonin-activated bilirubin UDP-glucuronyltransferase activity was decreased in both, as is usually found in patients with Gilbert's syndrome. In the patients examined the slight and variable hyperbilirubinaemia associated with Gilbert's syndrome seemed thus to have been aggravated because of the decreased food intake due to achalasia. This situation may be compared to the jaundice sometimes found in neonates with pyloric stenosis or other types of obstruction of the upper gastrointestinal tract. Observations in rats and man favour a complex mechanism for fasting-induced hyperbilirubinaemia.<\/jats:p>","DOI":"10.1136\/gut.15.2.121","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"121-124","source":"Crossref","is-referenced-by-count":6,"title":["Unconjugated hyperbilirubinaemia in achalasia"],"prefix":"10.1136","volume":"15","author":[{"given":"J.","family":"Fevery","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. P. 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Med"},{"key":"ref_16","first-page":"73","article-title":"Hyperbilirubinaemia: significance of the ratio between directreacting and total bilirubin. Clin chim","volume":"17","author":"Fevery, J.; Claes, J.; Heirwegh, K.; De Groote, J.","year":"1967","unstructured":"Fevery, J., Claes, J., Heirwegh, K., and De Groote, J. (1967). Hyperbilirubinaemia: significance of the ratio between directreacting and total bilirubin. Clin chim. Acta, 17, 73-79.","journal-title":"Acta"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1042\/bj1290619","article-title":"Enzymic transfer of glucose and xylose from uridine diphosphate glucose and uridine diphosphate xylose to bilirubin by untreated and digitonin-activated preparations from rat liver","volume":"129","author":"Fevery, J.; Leroy, P.; Heirwegh, K.P.M.","year":"1972","unstructured":"Fevery, J., Leroy, P., and Heirwegh, K. P. M. (1972). 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Sci"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00005792-195902000-00002","article-title":"Constitutional hepatic dysfunction (Gilbert's disease): its natural history and related syndromes","volume":"38","author":"Foulk, W.T.; Butt, H.R.; Owen, Jr., C.A.; Whitcomb, Jr., F.F.; Mason, H.L.","year":"1959","unstructured":"Foulk, W. T., Butt, H. R., Owen, C. A., Jr., Whitcomb, F. F., Jr., and Mason, H. L. (1959). Constitutional hepatic dysfunction (Gilbert's disease): its natural history and related syndromes. Medicine (Baltimore), 38, 25-46.","journal-title":"Medicine (Baltimore)"},{"key":"ref_20","first-page":"1","volume":"289","author":"Jendrassik, L.; Cleghorn, R.A.","year":"1936","unstructured":"Jendrassik, L., and Cleghorn, R. A. (1936). Photometrische Bilirubinbestimmung. Biochem. Z., 289, 1-14.","journal-title":"Photometrische Bilirubinbestimmung. Biochem. 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Chem"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"421","DOI":"10.3109\/00365517209080280","article-title":"Enhancement of heme catabolism by caloric restriction in man","volume":"30","author":"Lundh, B.; Johansson, M.B.; Mercke, C.; Cavallin-Stahl, E.","year":"1972","unstructured":"Lundh, B., Johansson, M. B., Mercke, C., and Cavallin-Stahl, E. (1972). Enhancement of heme catabolism by caloric restriction in man. Scand. J. clin. Lab. Invest., 30, 421-427.","journal-title":"Scand. J. clin. Lab. Invest"},{"key":"ref_26","article-title":"Bilirubin glucuronyl transferase activity in liver disease","author":"Metge, W.R.; Owen, Jr., C.A.; Foulk, W.T.; Hoffman, H.N.","year":"1964","unstructured":"Metge, W. R., Owen, C. A., Jr., Foulk, W. T., and Hoffman, H. N. (1964). Bilirubin glucuronyl transferase activity in liver disease."},{"key":"ref_27","first-page":"\"8P.\" # \"1108","article-title":"Bilirubin-binding properties of plasma and liver cytosol preparations from rats","volume":"126","author":"Meuwissen, J.A.T.P.; Fevery, J.; Heirwegh, K.P.M.","year":"1971","unstructured":"Meuwissen, J. A. T. P., Fevery, J., and Heirwegh, K. P. M. (1971). Bilirubin-binding properties of plasma and liver cytosol preparations from rats. Biochem. J., 126, 8P. Powell, L. W., Hemingway, E., Billing, B. H., and Sherlock, S. (1967). Idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome): a study of 42 families. New Engl. J. Med., 277, 1108-1112.","journal-title":"Biochem. J; Idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome): a study of 42 families"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1073\/pnas.61.2.748","article-title":"The enzymatic conversion of heme to bilirubin by microsomal heme oxygenase","volume":"61","author":"Tenhunen, R.; Marver, H.S.; Schmid, R.","year":"1968","unstructured":"Tenhunen, R., Marver, H. S., and Schmid, R. (1968). The enzymatic conversion of heme to bilirubin by microsomal heme oxygenase. Proc. nat. Acad. Sci. (Wash.), 61, 748-755.","journal-title":"Proc. nat. Acad. Sci. (Wash.)"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1203\/00006450-197203000-00008","article-title":"Enzymatic conversion of heme to bilirubin in normal and starved fetuses and newborn rats","volume":"6","author":"Thaler, M.M.; Gemis, D.L.; Bakken, A.F.","year":"1972","unstructured":"Thaler, M. M., Gemis, D. L., and Bakken, A. F. (1972). 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