Investigation of autonomic function and orocecal transit time in patients with nonalcoholic cirrhosis and the potential influence of these factors on disease outcome.
BACKGROUND
The presence of autonomic dysfunction in nonalcoholic cirrhosis and its influence on intestinal transit and disease outcome still need clarification.


OBJECTIVE
To investigate the function of the autonomic nervous system in patients with nonalcoholic cirrhosis and the possible associations among autonomic dysfunction, severity of liver disease, disturbed intestinal transit, and the development of complications during follow-up.


METHODS
Measurements of heart rate variability obtained by analysis of 24-hour ambulatory electrocardiographic recordings to assess autonomic function and lactulose breath hydrogen test to determine orocecal transit time were performed in 32 patients with nonalcoholic cirrhosis divided into Child A and B.


RESULTS
Child B patients showed significantly lower values (P<0.05) of those parameters reflecting parasympathetic (high frequency, log-transformed high frequency, pNN50) and sympathetic function (low frequency, log-transformed low frequency) in comparison with controls and Child A patients. Orocecal transit time values were significantly (P=0.02) higher in Child B patients than in controls, but no relationship was found between delayed orocecal transit time and autonomic dysfunction. During follow-up, 42% of Child B patients developed encephalopathy. This complication was significantly associated with autonomic dysfunction. In addition, in the 4 patients who died the parameters reflecting parasympathetic function were significantly reduced in comparison with those of survivors.


CONCLUSIONS
Autonomic dysfunction and delayed intestinal transit are related to the severity of disease in nonalcoholic cirrhosis. Autonomic dysfunction seems to predispose cirrhotic patients to the development of encephalopathy and may be associated with a poor prognosis of these patients.
Nagasako
Cristiane Kibune
CK
Gastroenterology Division, Laboratory of Gastroenterology and Hepatology, Gastrocentro, Faculty of Medical Sciences, University of Campinas, SP, Brazil.
de Oliveira Figueiredo
Márcio Jansen
MJ
de Souza Almeida
Jazon Romilson
JR
Lorena
Sônia Letícia Silva
SL
Akasaka
Helena Midori
HM
Pavan
Célia Regina
CR
Yamanaka
Ademar
A
Pereira
Tiago Sevá
TS
Soares
Elza Cotrim
EC
Mesquita
Maria Aparecida
MA
D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001944:Breath Tests; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory; D005260:Female; D005772:Gastrointestinal Transit; D006339:Heart Rate; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007792:Lactulose; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors
D007792:Lactulose