title: Shared symptoms and putative biological mechanisms in chronic liver disease: implications for biobehavioral research.
abstract: Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver-gut-brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.
authors.affiliation: Virginia Commonwealth University School of Nursing, Richmond, VA, USA vsmenzies@vcu.edu.
authors.forename: Victoria
authors.initials: V
authors.lastname: Menzies
authors.affiliation: Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Jallo
authors.affiliation: Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Kinser
authors.affiliation: Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Jo Lynne W
authors.initials: JL
authors.lastname: Robins
authors.affiliation: Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Kyungeh
authors.initials: K
authors.lastname: An
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Driscoll
authors.affiliation: Virginia Commonwealth University School of Nursing, Richmond, VA, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Starkweather
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Jasmohan S
authors.initials: JS
authors.lastname: Bajaj
authors.affiliation: College of Nursing, University of Florida, Gainesville, FL.
authors.forename: Debra E
authors.initials: DE
authors.lastname: Lyon
mesh_terms: D000066949:Biobehavioral Sciences; D002490:Central Nervous System / Q000503:physiopathology; D006801:Humans; D007107:Immune System / Q000503:physiopathology; D008107:Liver Diseases / Q000503:physiopathology* / Q000523:psychology*; D013577:Syndrome
keywords: biobehavioral; liver disease; mechanisms; symptoms