Avaliação da função autonomica e do transito intestinal em pacientes com cirrose hepatica de etiologia não alcoolica / Investigation of autonomic function and orocrecal transit time in patients with non-alcoholic cirrrhosis : association of autonomic dysfunction with severity of cirrhosis and the occurrence of new onset encephalopathy

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Autonomic dysfunction (AD) is common in patients with alcoholic hepatic cirrhosis but information on its occurrence and clinical relevance in patients with non-alcoholic liver disease is contradictory. 24-hour heart rate variability (HRV) is considered to be more sensitive than the cardiovascular reflexes to detect autonomic damage. Only a few studies used this technique in the investigation of autonomic function in cirrhotic patients. Previous studies have demonstrated that intestinal transit is delayed in patients with cirrhosis, and that this alteration predisposes to bacterial overgrowth, bacterial translocation and risk of infections. The reasons for that remain unclear. Since the autonomic nervous system participates in the regulation of gastrointestinal motility, it seems likely that AD may play a role in the intestinal motility alterations observed in cirrhosis. Therefore, our aims were to assess autonomic function in patients with non-alcoholic hepatic cirrhosis, and to investigate the relationship of AD with severity of disease, delayed intestinal transit and the clinical outcome. Thirty four patients with non-alcoholic hepatic cirrhosis classified as Child?s A (n=13) and Child? B/C (n=21) were studied. Autonomic function was assessed by using standard cardiovascular reflexes tests and 24- hour HRV analysis. Orocaecal transit time (OCTT) was measured using the lactulose hydrogen breath test. According to cardiovascular reflexes tests, 4 patients Child A (30.8%) and 6 patients Child B?C (28.4%), were found to have evidence of parasympathetic damage. The 24-hour HRV analysis showed that parameters reflecting parasympathetic (HF, lnHF, pNN50) and sympathetic (LF, lnLF) function were significantly decreased (p<0,05) in comparison with both controls and Child?s A patients. Individual analysis showed parasympathetic damage in three patients Child A (23,1%) and in 12 (57%) Child B?C (p=0.07). Eight patients had combined sympathetic damage. No diference was found in OCTT values between Child? A patients (52±17 minutes) and controls (52±13 min). In contrast, OCTT values were significantly higher in Child? B?C patients (71±34minutes) than in controls. Bacterial overgrowth occurred in only two patients. The mean follow-up time was 19±12 months. At the end of the study, five Child?s B/C patients (24%) have died. The values of parameters representative of parasympathetic function (HF, lnHF) were significantly lower (p<0.05) in these patients in comparison with survivors of Child?s B/C group. Hepatic encephalopathy was the most frequent complication during follow-up, occurring in 42.8% of Child?s B/C patients. AD was significantly associated with encephalopathy (p<0.05), but did not correlate with OCTT values. In conclusion, our study showed that autonomic dysfunction in common in patients with non-alcoholic liver disease and is related to the severity of hepatic dysfunction. Our results did not show a relationship between delayed intestinal transit and AD. The presence of autonomic damage predisposes these patients to the development of encephalopathy and may be associated to higher mortality

ASSUNTO(S)

cirrose hepatica liver cirrhosis encefalopatias brain disease

ACESSO AO ARTIGO

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