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Evaluation of autonomic neuropathy in alcoholic liver disease in Manipur

Context: The prevalence of autonomic neuropathy in alcoholic liver disease and its correlation with severity of liver disease is not known in Manipur population. Aims: The aim of this study was to study the prevalence of autonomic dysfunction in patients with chronic alcoholic liver disease and to determine the degree of severity of alcoholic liver disease by Child–Turcotte-Pugh scoring and its correlation with autonomic profile. Settings and Design: A cross-sectional study involving eighty adult patients with chronic alcoholic liver attending Medicine out patient's Department in a tertiary care teaching hospital in Imphal, from October 2011 to September 2013. Subjects and Methods: Autonomic profile included a preformed questionnaire and five autonomic function tests (3 parasympathetic and 2 sympathetic). Parasympathetic tests (heart rate variation to [1] deep and slow breathing, [2] Valsalva maneuver, and [3] standing) and sympathetic tests (blood pressure response to [1] postural change and [2] sustained isometric hand grip) were performed. Autonomic neuropathy detected was graded as normal, early, definite, severe, and atypical. Results: Autonomic dysfunction was observed in 58 (72.5%) patients (early 30 [37.5%], definite 10 [12.5%], severe 18 [22.5%], normal 22 [27.5%]). Heart rate response to standing (30:15 ratio) was the most altered parasympathetic test in 39 (67.2%). The parameters that correlated with the severity of autonomic dysfunction were Child–Pugh scoring (P = 0.000), platelet count (P = 0.000, cirrhosis (P = 0.001), varices (P = 0.02), and portal hypertension (P = 0.000). Conclusions: Screening of alcoholic liver disease patients with autonomic function tests directly correlated with the severity of alcoholic liver disease. Autonomic tests should be a part of patient work in alcoholic liver disease so that early intervention can be performed.