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Autonomic dysfunction in primary biliary cirrhosis correlates with fatigue severity.
Julia L Newton1, Adrian Davidson, Simon Kerr
1Cardiovascular Investigation Unit, University of Newcastle, Care of the Elderly Offices, Royal Victoria Infirmary, UK. julianewton@blueyonder.co.uk
European Journal of Gastroenterology & Hepatology
|February 3, 2007
Summary
Autonomic dysfunction is nearly universal in primary biliary cirrhosis patients, affecting both noncirrhotic and cirrhotic stages. This dysfunction is closely linked to the severity of fatigue experienced by patients.
Area of Science:
- Hepatology
- Neurology
- Cardiology
Background:
- Autonomic dysfunction is recognized in primary biliary cirrhosis.
- Fatigue in nonhepatic diseases correlates with autonomic dysfunction and baroreflex sensitivity.
- This study examines autonomic dysfunction and fatigue in primary biliary cirrhosis across disease stages.
Purpose of the Study:
- To determine the prevalence of autonomic dysfunction in primary biliary cirrhosis using sensitive methods.
- To investigate the relationship between autonomic dysfunction and fatigue in primary biliary cirrhosis patients.
- To compare autonomic function in cirrhotic versus noncirrhotic primary biliary cirrhosis patients.
Main Methods:
- Autonomic reflex tests were conducted on 47 primary biliary cirrhosis patients and controls.
- Continuous blood pressure and electrocardiograph measurements were utilized.
- Fatigue was assessed using the primary biliary cirrhosis-40 questionnaire.
Main Results:
- Autonomic dysfunction was present in 100% of precirrhotic and 81% of cirrhotic primary biliary cirrhosis patients.
- Primary biliary cirrhosis patients showed significantly lower parasympathetic function (Valsalva ratio, 30:15 ratio) and impaired sympathetic function (blood pressure drop on standing).
- Increased fatigue correlated with reduced baroreflex sensitivity and sympathetic overactivity.
Conclusions:
- Autonomic dysfunction is highly prevalent, nearly universal, in primary biliary cirrhosis at all stages.
- Sensitive detection modalities reveal a higher prevalence than previously understood.
- Abnormalities in autonomic function are associated with fatigue in primary biliary cirrhosis.
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