title: Investigation of autonomic function and orocecal transit time in patients with nonalcoholic cirrhosis and the potential influence of these factors on disease outcome.
abstract: 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.
authors.affiliation: Gastroenterology Division, Laboratory of Gastroenterology and Hepatology, Gastrocentro, Faculty of Medical Sciences, University of Campinas, SP, Brazil.
authors.forename: Cristiane Kibune
authors.initials: CK
authors.lastname: Nagasako
authors.forename: Márcio Jansen
authors.initials: MJ
authors.lastname: de Oliveira Figueiredo
authors.forename: Jazon Romilson
authors.initials: JR
authors.lastname: de Souza Almeida
authors.forename: Sônia Letícia Silva
authors.initials: SL
authors.lastname: Lorena
authors.forename: Helena Midori
authors.initials: HM
authors.lastname: Akasaka
authors.forename: Célia Regina
authors.initials: CR
authors.lastname: Pavan
authors.forename: Ademar
authors.initials: A
authors.lastname: Yamanaka
authors.forename: Tiago Sevá
authors.initials: TS
authors.lastname: Pereira
authors.forename: Elza Cotrim
authors.initials: EC
authors.lastname: Soares
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Mesquita
mesh_terms: 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
chemical_list: D007792:Lactulose