Prevalence of autonomic dysfunction in cirrhotic and noncirrhotic portal hypertension

Rangari, Manisha; Sinha, Shalini; Kapoor, Dharmesh; Mohan, Jagdish C.; Sarin, Shiv Kumar

doi:10.1016/s0002-9270(01)04113-2

Cited by 13 publications

(18 citation statements)

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“…IL‐1β contributes to neuroglial damage, which compromises MSC and Schwann cell survival . Autonomic dysfunction observed in advanced cirrhosis can also contribute to the BM neural fiber deterioration.…”

Section: Discussionmentioning

confidence: 99%

Bone marrow stem cells and their niche components are adversely affected in advanced cirrhosis of the liver

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Bone marrow stem cells and their niche components are adversely affected in advanced cirrhosis of the liver

et al. 2016

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“…A generalized source is suspected, as adrenergic, cardiovagal, and peripheral systems are affected. Although the majority of autonomic dysfunction in patients with liver disease occurs in cirrhosis, it has been described in a series of patients with noncirrhotic portal hypertension as well 10…”

Section: Discussionmentioning

confidence: 99%

The effect of liver transplantation on autonomic dysfunction in patients with end-stage liver disease

et al. 2008

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Autonomic dysfunction is a recognized complication of end-stage liver disease (ESLD), but there is little information on how liver transplantation (LT) affects this problem. We sought to prospectively evaluate autonomic function in patients with ESLD before and after LT. Autonomic reflex screen (ARS) was performed on 30 patients with ESLD prior to transplantation. A 10-point composite autonomic score (CAS) was calculated from these data. ARS was repeated after LT, and these scores were compared with the pre-LT ARS. Thirty patients (25 male, 5 female) with cirrhosis that were listed for LT were enrolled in the study and underwent ARS prior to LT. The average age was 55.4 Ϯ 9.1 years. Indications for LT included hepatitis C virus (14), cryptogenic cirrhosis (5), alcoholic cirrhosis (4), and other (7). The mean native Model for End-Stage Liver Disease (MELD) score at ARS was 17.0 Ϯ 5.0. Prior to LT, 86.7% of patients had evidence of autonomic dysfunction. Mean CAS was 2.7 Ϯ 2.2. Sudomotor function was disturbed in 66%, parasympathetic function was disturbed in 57%, and adrenergic function was disturbed in 37%. There was no relationship between pre-LT CAS and age, gender, diabetes, etiology of liver disease, or MELD score. Twenty-one patients (17 male, 4 female) had repeat ARS a mean of 9 Ϯ 6.2 months after LT. The mean native MELD score at the time of ARS testing was 18.1 Ϯ 4.3. Mean pre-LT CAS in this group was 3.0 Ϯ 2.4. Pretransplant CAS was not related to age, gender, diabetes, or MELD score. Autonomic dysfunction improved after LT (CAS pre-LT, 3.0, versus CAS post-LT, 1.9, P ϭ 0.02). There was no relationship between post-LT CAS and age, gender, diabetes, etiology of liver disease, immunosuppression, or type of transplant. In conclusion, autonomic dysfunction is common in patients with ESLD, with over 86% having abnormal testing. Sixty-three percent of patients with cirrhosis with autonomic dysfunction show improvement after LT. Liver Transpl 14:235-239, 2008 Autonomic neuropathy is recognized in up to 68%-80% of patients with cirrhosis.

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“…Autonomic dysfunction is increasingly being recognized in patients with cirrhosis. We have recently observed these anomalies in EHPVO patients, possibly because these patients do have some degree of hepatic dysfunction 43 . However, autonomic dysfunction does occur even in patients with NCPF, with near‐normal liver function, suggesting some contribution of PTH per se.…”

Section: Laboratory Featuresmentioning

confidence: 95%

Non‐cirrhotic portal fibrosis: Current concepts and management

Sarin

Kapoor

2002

J of Gastro and Hepatol

150

183

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Non-cirrhotic portal hypertension (NCPH) comprises diseases having an increase in portal pressure (PP) due to intraheptic or prehepatic lesions, in the absence of cirrhosis. The lesions are generally vascular, either in the portal vein, its branches or in the perisinusoidal area. Because the wedged hepatic venous pressure is near normal, measurement of intravariceal or intrasplenic pressure is needed to assess PP. The majority of diseases included in the category of NCPH are well-characterized disease entities where portal hypertension (PHT) is a late manifestation and, hence, these are not discussed. Two diseases that present only with features of PHT and are common in developing countries are non-cirrhotic portal fibrosis (NCPF) and extrahepatic portal vein obstruction (EHPVO). Non-cirrhotic portal fibrosis is a syndrome of obscure etiology, characterized by 'obliterative portovenopathy' leading to PHT, massive splenomegaly and well-tolerated episodes of variceal bleeding in young adults from low socioeconomic backgrounds, having near normal hepatic functions. In some parts of the world, NCPF is called idiopathic portal hypertension (IPH) or 'hepatoportal sclerosis'. Because 85-95% of patients with NCPF and EHPVO present with variceal bleeding, treatment involves management with endoscopic sclerotherapy (EST) or variceal ligation (EVL). These therapies are effective in approximately 90-95% of patients. Gastric varices are another common cause of upper gastrointestinal bleeding in these patients and these can be managed with cyanoacrylate glue injection or surgery. Other indications for surgery include failure of EST/EVL, and symptomatic hypersplenism. The prognosis of patients with NCPF is good and 5 years survival in patients in whom variceal bleeding can be controlled has been reported to be approximately 95-100%.

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Prevalence of autonomic dysfunction in cirrhotic and noncirrhotic portal hypertension

Cited by 13 publications

References 0 publications

Bone marrow stem cells and their niche components are adversely affected in advanced cirrhosis of the liver

Bone marrow stem cells and their niche components are adversely affected in advanced cirrhosis of the liver

The effect of liver transplantation on autonomic dysfunction in patients with end-stage liver disease

Non‐cirrhotic portal fibrosis: Current concepts and management

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