Autonomic dysfunction and gastroparesis in cirrhosis.
BACKGROUND
Patients with cirrhosis of the liver frequently present with many gastrointestinal complaints that are most likely due to abnormal gastrointestinal motility. The cause of these motility disorders in cirrhotics is unknown, however, underlying autonomic dysfunction may play a role.


OBJECTIVE
To determine the association between autonomic dysfunction and delayed gastric emptying in cirrhotic patients.


METHODS
We prospectively studied 20 patients with cirrhosis of the liver and postprandial abdominal pain, nausea, and vomiting and 10 asymptomatic patients with Hepatitis C (HCV) and no evidence of cirrhosis. All patients underwent 5 standardized cardiovascular tests to assess autonomic function. Each test was scored on a continuum from 0 (normal) to 5 (severe disease), thus producing a composite score of 0 to 5 for each subject. A composite score of greater than 1.5 was considered abnormal, with 5 representing severe autonomic involvement. A solid phase gastric emptying study was performed in each patient and a gastric retention of greater than 50% at 100 minutes was considered abnormal.


RESULTS
The mean percent retention at 100 minutes was 70.7% in the cirrhotic group vs. 26.1% (P < 0.001) in the patients with HCV and no evidence of cirrhosis (controls). The composite autonomic score for the cirrhotic group was 3.4 vs. 1.2 (P < 0.001) in the controls.


CONCLUSIONS
Our results suggest that gastroparesis is common in patients with cirrhosis of the liver, and may account for gastrointestinal symptoms of postprandial abdominal pain, nausea, and vomiting. The presence of autonomic dysfunction correlates positively with underlying motility disorders, such as delayed gastric emptying.
Verne
G Nicholas
GN
Divisions of Gastroenterology, Hepatology, and Nutrition, University of Florida, Malcom Randall VAMC, 1601 SW Archer Road, Gainesville, FL 32608, USA. vernegn@medicine.ufl.edu
Soldevia-Pico
Consuelo
C
Robinson
Michael E
ME
Spicer
Kenneth M
KM
Reuben
Adrian
A
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology*; D006339:Heart Rate; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies