Autonomic neuropathy in liver cirrhosis: relationship with alcoholic aetiology and severity of the disease.
Autonomic neuropathy has been frequently observed in alcohol-addicts both with and without liver disease but few data are available on non-alcoholic cirrhotics. We studied the prevalence of this disorder in 113 cirrhotics (41 alcoholics and 72 non-alcoholics) to correlate it both with residual liver efficiency and the aetiology of liver cirrhosis. We used 5 cardio-vascular tests commonly adopted to assess the parasympathetic [Valsalva manoeuvre (VR), deep breathing (DB), lying-to-standing (LS)] and sympathetic function [sustained handgrip (SH) and orthostatic hypotension (OH)]. Results obtained indicate that: a) autonomic neuropathy was observed in 60% of the patients (71% in alcoholic and 57% in non-alcoholic cirrhosis; p < 0.01); b) the alterations of the parasympathetic function are significantly more frequent than those of the sympathetic function; c) DB and SH tests seem to be influenced by the compliance of the patient; DB was the most altered test and LS was the most specific and sensitive test; d) a simplified series of three diagnostic tests (2 parasympathetic: VR and LS, plus a sympathetic one: HO) is as accurate for the diagnosis as the combination of the 5 tests.
Gentile
S
S
Istituto di Medicina Generale e Metodologia Clinica, II Università di Napoli, Italy.
Marmo
R
R
Peduto
A
A
Montella
F
F
Coltorti
M
M
D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D007024:Hypotension, Orthostatic; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D014636:Valsalva Maneuver