Autonomic dysfunction has previously been described in primary biliary cirrhosis patients.
In nonhepatic diseases, fatigue is associated with autonomic dysfunction and impaired baroreflex sensitivity.
Dr Julia Newton and colleagues investigated the prevalence of autonomic dysfunction and its relationship with fatigue in noncirrhotic and cirrhotic primary biliary cirrhosis.
The research team performed autonomic reflex tests in 47 primary biliary cirrhosis patients, and age and sex-matched controls.
The team used continuous blood pressure and electrocardiograph measurements.
|Increasing fatigue was associated with sympathetic overactivity|
|European Journal of Gastroenterology & Hepatology|
Fatigue was measured using the primary biliary cirrhosis-40.
The researchers reported that 100% of precirrhotic and 81% of cirrhotic primary biliary cirrhosis patients exhibited autonomic dysfunction.
Valsalva ratio and other measures of parasympathetic autonomic dysfunction were significantly lower in primary biliary cirrhosis patients than in controls.
Blood pressure drop on standing was used to measure sympathetic autonomic dysfunction.
The research team found that blood pressure drop on standing was greater in the primary biliary cirrhosis group.
The team noted that valsalva phase IV size was similar between primary biliary cirrhosis patients and controls.
However, the researchers observed that time to phase IV was significantly longer, suggesting adrenergic failure.
Increasing fatigue was associated with impaired baroreflex sensitivity and an earlier, bigger phase IV, indicating sympathetic overactivity.
The researchers observed no significant differences between cirrhotic and noncirrhotic patients.
Dr Newton's team commented, “The prevalence of autonomic dysfunction in primary biliary cirrhosis patients is significantly higher than has previously been thought to be the case.”
“Indeed, when sensitive detection modalities are used, it is found to be almost universal at all stages of the disease process.”
“Fatigue in primary biliary cirrhosis is associated with abnormalities of autonomic function.”