Autonomic neuropathy in extra-hepatic portal vein thrombosis: evidence for impaired autonomic reflex arc

Background/Aims: Automatic dysfunction is common in cirrhosis, and may be associated with increased mortality and hyperdynamic circulatory changes. Our aim was to investigate whether autonomic disturbances occur in extrahepatic portal vein thrombosis and their correlation with hemodynamic abnormalities. Patients and Methods: Heart rate variation in response to standing, deep breathing, and Valsalva maneuver, and blood pressure response to sustained handgrip and to standing, were studied in 16 subjects with portal vein thrombosis (10 males, 30.8±2.8 years: mean±SE), 12 with cirrhosis (7 males, 52±2.3 years), and 10 healthy controls (7 males, 30.8±3.0 years). Supine resting, and 10- and 30-min standing epinephrine and norepinephrine levels were measured and results correlated with cardiac output. Results: Automatic dysfunction occurred in 62% of portal vein thrombosis and 75% of cirrhosis subjects, but in no controls ( p