Population prevalence and symptom associations of autonomic dysfunction in primary biliary cirrhosis
Open Access
- 30 May 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Hepatology
- Vol. 45 (6), 1496-1505
- https://doi.org/10.1002/hep.21609
Abstract
Patients with primary biliary cirrhosis (PBC) frequently experience significant fatigue thought to result from as‐yet‐unidentified central nervous system (CNS)‐mediated processes. Pilot studies have suggested that autonomic dysfunction is a frequent occurrence in PBC and may contribute to the pathogenesis of this fatigue. The degree to which autonomic dysfunction affects the PBC population as a whole, and its interrelationship with other symptoms experienced by PBC patients remains unstudied. In this study, we used a geographically defined, fully representative PBC patient cohort to study the prevalence of symptoms of autonomic dysfunction and its relationship with other symptoms of PBC. Symptoms of cardiovascular autonomic dysfunction (as assessed using the Orthostatic Grading Scale [OGS]) were significantly more frequently reported and significantly more severe in PBC patients than in both matched normal controls (40% versus 6% with moderate or worse orthostasis (P < .0001), mean OGS score 3.2 ± 3.4 versus 1.3 ± 1.9, P < .005) and in patients with primary sclerosing cholangitis and in severity were independently associated with severity of fatigue and cognitive symptoms (both r 2 = 0.3, P < .0001). Thirteen of 20 patients with an OGS value > 4 (moderate severity and worse) had significant abnormality in autonomic regulation of blood pressure, which was identified on dynamic testing. Conclusion: Symptoms suggestive of autonomic dysfunction frequently occur in PBC patients and reflect dysregulation of actual blood pressure. Autonomic dysfunction is independently associated with both fatigue and, importantly, symptoms of cognitive dysfunction, suggesting the potential for significant organic sequelae. (HEPATOLOGY 2007;45:1496–1505.)This publication has 40 references indexed in Scilit:
- TNF-α-secreting monocytes are recruited into the brain of cholestatic miceJournal of Hepatology, 2005
- Quality of life in patients with primary biliary cirrhosisJournal of Hepatology, 2004
- The true impact of fatigue in primary biliary cirrhosis: A population studyGastroenterology, 2002
- Impact of fatigue on the quality of life of patients with primary biliary cirrhosisThe American Journal of Gastroenterology, 2000
- Validation of a fatigue impact score in primary biliary cirrhosis: towards a standard for clinical and trial useJournal of Hepatology, 2000
- Primary biliary cirrhosis once rare, now common in the United Kingdom?Journal of Hepatology, 1999
- Augmented interleukin-1?-induced depression of locomotor activity in cholestatic ratsJournal of Hepatology, 1998
- Fatigue in primary biliary cirrhosisGut, 1998
- Chronic cholestasis in rats induces anhedonia and a loss of social interestJournal of Hepatology, 1998
- Improvement in cholestasis-associated fatigue with a serotonin receptor agonist using a novel rat model of fatigue assessmentJournal of Hepatology, 1997