Autonomic dysfunction in patients with non-alcoholic chronic liver disease

Aims: To assess the presence of autonomic neuropathy in patients with non-alcoholic chronic liver disease and its relationships with the severity of liver damage. Methods: Thirty non-alcoholic patients with chronic liver disease and 26 healthy control subjects were studied. The silicone imprint technique was used to quantify the number of functioning sweat glands in order to assess peripheral sympathetic dysfunction. Heart rate variations in response to deep breathing at 6 per minute (ΔR6), to a Valsalva maneuver, and with orthostatism (RR(max)/RR(min)) were determined to assess parasympathetic vagal function. Results: Mean values for autonomic tests were significantly lower in the group of patients with non-alcoholic chronic liver disease than in the control subjects. The number of activated sweat glands in the foot was abnormal in 19 (63%) patients. Among vagal tests, Valsalva ratio was abnormal in 14 (46%) and ΔR6 in 11 (36%) patients with liver disease. Vagal neuropathy (two or more abnormal heart rate tests) was definite in nine patients (30%). Conclusions: A high prevalence of abnormalities in both sympathetic and parasympathetic function tests, with a poor relationship with liver function parameters, has been found in patients with non-alcoholic chronic liver disease.