Study of prevalence and pattern of peripheral neuropathy in patients with liver cirrhosis
DOI:
https://doi.org/10.18203/2349-3933.ijam20173228Keywords:
Diabetes mellitus, Liver cirrhosis, Peripheral neuropathy, Serum vitamin B12Abstract
Background: Peripheral neuropathy is not an uncommon complication of liver cirrhosis but it is not given much clinical relevance. The pattern and prevalence of peripheral neuropathy has also not been studied extensively. Alcohol use, coexisting diseases and nutritional deficiency have been postulated as factors responsible for neuropathy. The aim of this study was to define the pattern and prevalence of neuropathy in cirrhosis and to determine any etiologic correlation.
Methods: 85 patients of cirrhosis of liver were studied. Apart from routine investigations, serum vitamin B12 estimation was also done in these patients. Electrophysiological studies were done in 46 patients.
Results: Alcohol was the most common etiology of cirrhosis (57.6%). Hepatitis B related (11.8%) and Hepatitis C (4.7%) were other etiologies. The prevalence of peripheral neuropathy by electrophysiological studies was found to be 67.39% in cirrhosis of any etiology, of which 43.5% had sensorimotor type and the predominant pattern of peripheral neuropathy was mixed axonal degeneration and demyelination. The peripheral neuropathy was significantly more (p=0.01) in child class C than other child classes. Prevalence of neuropathy had no significant difference (p=1.00) between alcoholic and non-alcoholic cirrhosis. No correlation was present with either serum vitamin B12 levels or blood glucose levels.
Conclusions: Peripheral neuropathy is present in more than half of cirrhosis patients and is unrelated to etiology and nutritional status but related to the severity of cirrhosis.
References
Feldman M, Friedman LS, Lawrence JB, Sleisenger and Fordtran’s gastointestinal and liver disease - Pathophysiology/Diagnosis/Management 10th edition; Philadelphia. Saunders 2016;1254-74.
Chaudhry V, Corse AM, O'Brian R, Cornblath DR, Klein AS, Thuluvath PJ. Autonomic and peripheral (sensorimotor) neuropathy in chronic liver disease: a clinical and electrophysiologic study. Hepatol. 1999;29(6):1698-703.
Chari VR, Katiyar BC, Rastogi BL, Bhattacharya SK. Neuropathy in hepatic disorders. A clinical, electrophysiological and histopathological appraisal. J Neurol Sci. 1977;31:93-111.
Kharbanda PS, Chawla YK, Das CP, Syal P. Peripheral neuropathy in liver cirrhosis. J Gastroenterol Hepatol. 2003;18:922-6.
Hendrickse MT, Thuluvath PJ, Triger DR. Natural history of autonomic neuropathy in chronic liver disease. Lancet. 1992;339(8807):1462-4.
Bajaj BK, Agarwal MP, Ram BK. Autonomic neuropathy in patients with hepatic cirrhosis. Postgrad Med J. 2003;79(933):408-11.
Jain J, Singh R, Banait S, Verma N, Waghmare S. Magnitude of peripheral neuropathy in cirrhosis of liver patients from central rural India. Annals Ind Academy Neurol. 2014Oct;17(4):409.
Perretti A, Gentile S, Balbi P, Persico M, Caruso G. Peripheral neuropathy in liver cirrhosis. A clinical and electrophysiological study. Ital J Gastroenterol. 1995;27:349-54.
Knill-Jones RP, Goodwill CJ, Dayan AD, Williams R. Peripheral neuropathy in chronic liver disease: Clinical, electrodiagnostic, and nerve biopsy findings. J Neurol Neurosurg Psychiatry. 1972;35:22-30.
Ahmed S, Payeng D, Das AK. Etiological profile of cirrhosis of liver from north east India with reference to their anti-hepatitis A virus seroprevalence. Oncol, Gastroenterol and Hepatol Reports. 2015;4(1).
Electrophysiologic and laboratory aids in the diagnosis of neuromuscular disease. In: Ropper AH, Samuels MA, Klein JP, eds. Adams and Victor's Principles of Neurology, 10th ed. New York: McGraw Hill: Medical Pub. Division; 2014:1289-1390.
Joge NP, Kumar V, Verma S, Gupta K, Misra. Vitamin B12 associated peripheral neuropathy in cirrhosis of liver: a cross sectional study, IOSR JDMS, 2016;15(12):73-77.
Wiegand J, Berg T. The etiology, diagnosis and prevention of liver cirrhosis, part 1 of a Series on liver cirrhosis. Dtsch Arztebl Int. 2013;110(6):85-91.
Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. Epub. 2006 Jun 23;45(4):529-38.
Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The epidemiology of cirrhosis in the United States: a population-based study, J Clin. Gastroenterol. 2015;49(8):690-6.
Tolman KG, Fonseca V, Dalpiaz A, Tan MH. Spectrum of liver disease in type 2 diabetes and management of patients with diabetes and liver disease. Diabetes Care. 2007;30:734-43.
Holstein A, Hinze S, Thiessen E, Plaschke A, Egberts EH. Clinical implications of hepatogenous diabetes in liver cirrhosis. J Gastroenterol Hepatol. 2002;17:677-81.
Merli M, Leonetti F, Riggio O. Glucose intolerance and insulin resistance in cirrhosis are normalized after liver transplantation. Hepatol. 1999;30:649-54.
Nishida T, Tsuji S, Tsujii M. Oral glucose tolerance test predicts prognosis of patients with liver cirrhosis. Am J Gastroenterol. 2006;101:70–5.
Garcia-Compean D, Jaquez-Quintana JO, Gonzalez-Gonzalez JA, Maldonaldo-Garza H. Liver cirrhosis and diabetes: risk factors, pathophysiology, clinical implications and management. World J Gastroenterol. 2009;15(3):280-8.
Clarkea M, Benmoussaa J, Penmetsaa AB. inaccuracies of hemoglobin A1c in liver cirrhosis: A Case Report. J Endocrinol Metab. 2016;6(1):30-2.
Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care. 2011;34(Suppl 2):S184-90.
Blendea MC, Thompson MJ, Malkani S. Diabetes and chronic liver disease: etiology and pitfalls in monitoring. Clinical Diabetes. 2010;28(4):139-44.
Koga M, Kasayama S, Kanehara H, Bando Y. CLD (chronic liver diseases)-HbA1C as a suitable indicator for estimation of mean plasma glucose in patients with chronic liver diseases. Diabetes Res Clin Pract. 2008;81(2):258-62.
Fierro B, Raimondo D, Castiglione MG, Migneco G, Scoppa F, Savettieri G. Peripheral nerve involvement in chronic liver disease. Clinical and electrophysiological study, Ital J Neurol Sci. 1986;7:589-90.
Dayan AD, Williams R. Demyelinating peripheral neuropathy and liver disease. Lancet. 1967;2:133-4.
