title: Alcohol abuse exaggerates autonomic dysfunction in chronic liver disease.
abstract: BACKGROUND
  Advanced chronic liver disease is characterized by peripheral arterial vasodilation and increased plasma catecholamine concentrations. These haemodynamic alterations may reflect impaired vascular responsiveness due to autonomic nerve dysfunction.
  
  
  METHODS
  Three established non-invasive tests based on the heart reactions to deep breathing (expiratory/inspiratory (E/I) ratio) and to tilt (acceleration and brake indices) were used to evaluate age-related autonomic nerve function in 27 patients with chronic alcoholic and non-alcoholic liver disease. Liver function was estimated by demethylating capacity. The results were compared with a control group consisting of 56 healthy individuals.
  
  
  RESULTS
  Overall, 12 patients (52%) had autonomic neuropathy (10 of 13 (77%) patients with alcoholic and 2 of 14 (14%) with non-alcoholic liver disease). Variance analysis showed that the age-corrected E/I ratio, but not the acceleration and brake indices, was significantly decreased compared with controls both in patients with alcoholic and non-alcoholic liver disease, indicating vagal nerve dysfunction (P < 0.0001 and 0.0133, respectively). The decrease in E/I ratio was also significantly more pronounced (-1.77 (0.62) (median (interquartile range)) versus 0.76 (0.70); P = 0.049) in patients with alcoholic compared with non-alcoholic liver disease. Furthermore, in contrast to non-alcoholics, patients with alcoholic liver disease were unable to increase their diastolic blood pressure after return to upright from a tilted position, indicating additional sympathetic neuropathy.
  
  
  CONCLUSIONS
  Autonomic, mainly vagal, nerve dysfunction is common in patients with liver diseases and is further exaggerated by alcohol abuse. Autonomic neuropathy may contribute to altered vascular responsiveness in patients with chronic liver diseases.
authors.affiliation: Gastroenterology-Hepatology Division, University of Lund, University Hospital of Malmö, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Lindgren
authors.forename: B
authors.initials: B
authors.lastname: Lilja
authors.forename: H
authors.initials: H
authors.lastname: Verbaan
authors.forename: G
authors.initials: G
authors.lastname: Sundkvist
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008108:Liver Diseases, Alcoholic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged