[Autonomic neuropathy in chronic liver diseases]

Autonomic neuropathy has been evaluated by various cardiovascular bedside tests in 99 patients with chronic alcoholism (33 alcoholics without liver disease, 33 patients with fatty liver and 33 with cirrhosis), in 10 patients with primary biliary cirrhosis, in 12 patients with cirrhosis of other origin, and in 40 healthy controls. Parasympathetic integrity was evaluated by beat-to-beat variation during deep breathing (6 min), Valsalva manouver and standing up, sympathetic function by blood pressure response to standing up and to sustained handgrip test. Autonomic reflex damage was found in all groups examined. Patients with alcoholic cirrhosis exhibited the most severe alterations. Our results suggest, that chronic hepatopathy itself presents a pathogenetic factor of autonomic neuropathy. Autonomic failure has to be considered as a possible cause of symptoms in liver diseases with all its prognostic consequences.