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Fatigue in Cirrhosis.

Krishnagopal Bhandari1, Dharmesh Kapoor1

  • 1Yashoda Hospitals, Secunderabad, India.

Journal of Clinical and Experimental Hepatology
|May 10, 2022
PubMed
Summary

Fatigue significantly impacts liver disease patients' quality of life. This review explores its complex causes, assessment, and management strategies, highlighting the lack of consensus on effective treatments.

Keywords:
6MWD, 6 min walk distanceACG, anterior cingulate gyrusADL, activities of daily livingBBB, blood-brain barrierBNST, bed nucleus of stria terminalisCEC, cerebral endothelial cellCFS, chronic fatigue syndromeCPET, cardio-pulmonary exercise testingCRH, corticotropin release hormoneDA, dopamineFAS, fatigue assessment scaleFIS, fatigue impact scaleFSS, fatigue severity scaleHGS, hand-grip strengthHPA, hypothalamus-pituitary-adrenalHR-QoL, health-related quality of lifeIADL, instrumental activities of daily livingME, meningo-encephalomyelitisME, meningoencephalitisNAFLD, nonalcoholic fatty liver diseaseNM, neuromuscularNO, nitric oxidePGE2, prostaglandinsPRO, patient-reported outcomesPROMIS-F, patient-reported outcome measure information system for fatiguePSC, primary sclerosing cholangitisSAMe, S-adenosyl-methionineSN, substantia nigraSPPB, short-physical performance batteryVAS-F, visual analog scalefatigueVTA, ventral tegmental areacentral fatiguechronic liver diseasehealth-related quality of life [HR-QoL]iNOS, inducible nitric oxide synthasepatient-related outcomes [PRO]peripheral fatiguevmPFC, ventromedial prefrontal cortex

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Area of Science:

  • Hepatology
  • Neurogastroenterology
  • Quality of Life Research

Background:

  • Fatigue is a prevalent and debilitating symptom in liver disease patients, significantly impairing health-related quality of life (HR-QoL).
  • The underlying pathophysiology of fatigue in liver disease is multifactorial and not fully understood, involving complex interactions between the liver, gut, skeletal muscle, and brain.
  • The liver's central role in energy metabolism and its communication with other organs underscore its importance in fatigue development.

Purpose of the Study:

  • To provide a comprehensive overview of fatigue in the context of liver disease.
  • To elucidate the pathophysiology, assessment methods, and impact of fatigue on chronic liver disease.
  • To review current and potential interventions for managing fatigue in this patient population.

Main Methods:

  • Literature review and synthesis of existing research on fatigue in liver disease.
  • Exploration of the concept, pathophysiology, and evaluation of fatigue.
  • Discussion of the impact of fatigue and various management strategies.

Main Results:

  • Fatigue in liver disease has both peripheral (neuromuscular) and central (neurotransmission) components.
  • Current management strategies include behavioral changes, pharmacotherapy, dietetic intervention, and exercise.
  • There is a notable lack of consensus regarding optimal management strategies for fatigue in liver disease patients.

Conclusions:

  • Fatigue is a critical issue in liver disease affecting HR-QoL, requiring further research into its pathogenesis.
  • Effective assessment in a clinical setting is crucial for understanding and addressing fatigue.
  • Developing evidence-based, consensus-driven management strategies is essential for improving patient outcomes.