Document Detail

Fatigue and primary biliary cirrhosis: association of globus pallidus magnetisation transfer ratio measurements with fatigue severity and blood manganese levels.
MedLine Citation:
PMID:  15016756     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM: Fatigue is the commonest symptom in primary biliary cirrhosis (PBC), affecting individuals at all stages of disease. The pathogenesis of fatigue in PBC is unknown although rat models suggest a central nervous system (CNS) cause. We examined the hypothesis that a CNS abnormality related to cholestasis, rather than cirrhosis per se, underlies this symptom.
PATIENTS AND METHODS: Fourteen patients with precirrhotic PBC (stage I-II disease), four patients with stage III-IV PBC, and 11 healthy women were studied using cerebral magnetisation contrast imaging and proton magnetic resonance spectroscopy (MRS).
RESULTS: The globus pallidus magnetisation transfer ratio (MTR), a quantifiable tissue characteristic that may be abnormal in the presence of normal magnetic resonance imaging, was significantly reduced in precirrhotic PBC patients compared with healthy controls. These measurements correlated with blood manganese levels and were more abnormal in the more fatigued subjects. There were no differences in MRS measurements between the three study groups, suggesting that the abnormal MTR was not related to hepatic encephalopathy.
CONCLUSION: This study suggests that impairments in liver function in PBC may adversely affect the brain long before the development of cirrhosis and hepatic encephalopathy, possibly as a result of altered manganese homeostasis within the CNS.
D M Forton; N Patel; M Prince; A Oatridge; G Hamilton; J Goldblatt; J M Allsop; J V Hajnal; H C Thomas; M Bassendine; D E J Jones; S D Taylor-Robinson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gut     Volume:  53     ISSN:  0017-5749     ISO Abbreviation:  Gut     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-03-12     Completed Date:  2004-04-23     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  587-92     Citation Subset:  AIM; IM    
Liver Unit, Faculty of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK.
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MeSH Terms
Brain / pathology
Chronic Disease
Fatigue / blood,  etiology*,  pathology
Globus Pallidus / metabolism*,  pathology
Liver Cirrhosis, Biliary / blood,  complications*,  pathology
Magnetic Resonance Imaging / methods
Magnetic Resonance Spectroscopy / methods
Manganese / blood*,  metabolism
Middle Aged
Reg. No./Substance:
Comment In:
Gut. 2004 Apr;53(4):475-7   [PMID:  15016736 ]

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