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Autonomic and sensory nerve dysfunction in primary biliary cirrhosis
Katalin Keresztes1, Ildikó Istenes, Aniko Folhoffer
11st Department of Medicine, Semmelweis University, Budapest, Hungary.
World Journal of Gastroenterology
|September 21, 2004
Summary
Peripheral sensory nerve and autonomic dysfunction are common in primary biliary cirrhosis (PBC). Twenty-four-hour heart rate variability (HRV) analysis is a sensitive tool for detecting these impairments, which correlate with disease severity.
Area of Science:
- Neurology
- Hepatology
- Cardiology
Background:
- Cardiovascular autonomic and peripheral sensory neuropathy are known complications of chronic liver diseases.
- Primary biliary cirrhosis (PBC) is an autoimmune liver disease with potential neurological complications.
Purpose of the Study:
- To assess the prevalence and risk factors for peripheral sensory nerve and autonomic dysfunction in patients with PBC.
- To utilize sensitive methods for detecting these dysfunctions.
Main Methods:
- Studied 24 female PBC patients and 20 age-matched healthy females.
- Assessed autonomic function using five cardiovascular reflex tests and 24-h heart rate variability (HRV) analysis.
- Evaluated peripheral sensory nerve function via current perception threshold (CPT) on median and peroneal nerves.
Main Results:
- 58% of PBC patients had abnormal cardiovascular reflex tests; 54% had peripheral sensory neuropathy.
- PBC patients showed reduced heart rate response to deep breathing, standing, and Valsalva maneuver, and a greater blood pressure drop upon standing.
- 24-h HRV parameters were significantly reduced in PBC patients, indicating sympathetic and parasympathetic impairment. Hyperesthesia was noted in peroneal nerve testing.
Conclusions:
- Autonomic and sensory nerve dysfunctions are frequent in PBC patients.
- 24-h HRV analysis is more sensitive than standard tests for detecting autonomic impairments.
- Hyperesthesia is a characteristic feature of peripheral neuropathy in PBC, potentially contributing to itching. Autonomic dysfunction correlates with disease severity and duration.