Does autonomic dysfunction in cirrhosis liver influence variceal bleed?
BACKGROUND
Autonomic dysfunction has been documented in cirrhosis liver. Its influence on variceal bleed is not known.


OBJECTIVE
To determine the autonomic function amongst variceal bleeders in cirrhosis of the liver.


METHODS
Fifty cirrhotics (variceal bleeders: 34) belonging to either sex, Childs B, age more than 15 years and non diabetic constituted the study group. Parasympathetic function tests included valsalva ratio (E:I ratio) and deep breathing test. (Max.-Min. heart rate); sympathetic function included postural fall of B.P and a rise in diastolic B.P. with sustained hand grip. A cirrhotic was considered to have 'True' autonomic dysfunction when both parasympathetic and one of the two sympathetic tests were abnormal.


RESULTS
The mean age for men was 39.64 + 10.6 yrs and for women 39.54 + 15.8 yrs. The male female ratio was 3.5:1. Only 10 of the 50 patients (all bleeders) had 'true' autonomic dysfunction i.e. 20%. Parasympathetic dysfunction alone was positive in 19 (38%) and sympathetic in 10 patients (20%). The E:I ratio (p < 0.001) and an increase in diastolic B.P. during sustained hand grip (p < 0.04) were significantly positive amongst variceal bleeders.


CONCLUSIONS
'True' autonomic dysfunction can predispose a cirrhotic to variceal bleed.
Joye Varghese
S
S
Medical Gastroenterology, Stanley Medical College Hospital, Chennai, India. joyvargese@gmail.com
Balan
N
N
Naveen
B
B
Caroline Selvi
K
K
Jayapalan
K
K
Jayanthi
V
V
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000150:complications*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000294:innervation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D014648:Varicose Veins / Q000473:pathology*