Understanding and Treating Fatigue in Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Jopson, Laura; Dyson, Jessica; Jones, David

doi:10.1016/j.cld.2015.08.007

Cited by 22 publications

(32 citation statements)

References 39 publications

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Section: Fatigue In Liver Diseasementioning

confidence: 99%

“…Most studies on the subject suggest that CLD‐associated fatigue is the most common complaint amongst patients and is clinically significant in up to 50% of patients . The personal impact of fatigue in patients with CLD can be substantial, with patients reporting that their fatigue interfered with many aspects of their lives, including physical activity (73%), family life (57%) and job performance (30%) . The majority of patients with NAFLD (up to 70%) and ALD (up to 75%) experience significant functional impairment (including fatigue and cognitive difficulties) that affect activities of daily living and which persists over time .…”

Section: Fatigue In Liver Diseasementioning

confidence: 99%

“…While the pathophysiology of fatigue is complex, any conceptual framework that is postulated to explain the genesis of fatigue as a symptom in patients with CLD needs to include the following features: (a) peripheral signalling pathways must exist that link the diseased liver to the brain, and that activation of these pathways in turn leads to; and (b) changes in neurotransmission within the brain that give rise to changes in behaviour, that are linked to the clinical expression of fatigue. It is apparent that communication pathways between the liver and the brain could result in changes in central neural activity leading to the development of subsequent sickness behaviours and associated symptoms, including fatigue …”

Section: Fatigue In Liver Diseasementioning

confidence: 99%

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Fatigue in chronic liver disease: New insights and therapeutic approaches

Swain

Jones

2018

Liver International

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The management of fatigue associated with chronic liver disease is a complex and major clinical challenge. Although fatigue can complicate many chronic diseases, it is particularly common in diseases with an inflammatory component. Fatigue can have both peripheral (i.e., neuromuscular) and central (i.e., resulting from changes in neurotransmission within the brain) causes. However, fatigue in chronic liver disease has strong social/contextual components and is often associated with behavioural alterations including depression and anxiety. Given the increasing awareness of patient-reported outcomes as important components of treatment outcomes and clinical research, there is a growing need to better understand and manage this poorly understood yet debilitating symptom. Although several pathophysiological mechanisms for explaining the development of fatigue have been generated, our understanding of fatigue in patients with chronic liver disease remains incomplete. A better understanding of the pathways and neurotransmitter systems involved may provide specific directed therapies. Currently, the management of fatigue in chronic liver disease can involve a combined use of methods to beneficially alter behavioural components and pharmacological interventions, of which several treatments have potential for the improved management of fatigue in chronic liver disease. However, evidence and consensus are lacking on the best approach and the most appropriate biochemical target(s) whilst clinical trials to address this issue have been few and limited by small sample size. In this review, we outline current understanding of the impact of fatigue and related symptoms in chronic liver disease, discuss theories of pathogenesis, and examine current and emerging approaches to its treatment.

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Section: Fatigue In Liver Diseasementioning

confidence: 99%

Section: Fatigue In Liver Diseasementioning

confidence: 99%

Section: Fatigue In Liver Diseasementioning

confidence: 99%

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Fatigue in chronic liver disease: New insights and therapeutic approaches

Swain

Jones

2018

Liver International

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“…Of note, weight‐bearing exercise should be implemented progressively and with care given the risk of hepatic osteodystrophy and fractures in patients with PBC . Fatigue in PBC has been shown to be unrelated to the severity of liver disease and unresponsive to treatment with UDCA . It is important to keep in mind that fatigue does not typically improve post‐LT, and therefore fatigue should not be considered an indication for LT regardless of its severity …”

Section: Primary Biliary Cholangitismentioning

confidence: 99%

“…Overview of the TRACE approach in the treatment of fatigue in PSC and PBC . In the absence of targeted therapy, the TRACE approach has been developed to help manage fatigue in PBC [and by extension, in PSC ]…”

Section: Primary Biliary Cholangitismentioning

confidence: 99%

Complications, symptoms, quality of life and pregnancy in cholestatic liver disease

Zakharia

Tabibian

Lindor

et al. 2017

Liver International

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Cholestatic liver diseases (CLDs) encompass a variety of disorders of bile formation and/or flow which generally result in progressive hepatobiliary injury and ultimately end-stage liver disease. Many patients with CLD are diagnosed between the ages of 20-50 years, a particularly productive period of life professionally, biologically and in other respects; it is not surprising, thus, that CLD is often associated with impaired health-related quality of life (HRQOL) and uncertainty regarding implications for and outcomes of pregnancy. Primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) are the most prominent CLDs, both having considerable morbidity and mortality and representing major indications for liver transplantation. These disorders, as a consequence of their complications (eg ascites, hepatic osteodystrophy), associated conditions (eg inflammatory bowel disease) and symptoms (eg pruritus and fatigue), can significantly impair an array of domains of HRQOL. Here we review these impactful clinical aspects of PSC and PBC as well as the topics of fertility and pregnancy.

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Primary Biliary Cholangitis

Floreani

2021

Diseases of the Liver and Biliary Tree

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Understanding and Treating Fatigue in Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Cited by 22 publications

References 39 publications

Fatigue in chronic liver disease: New insights and therapeutic approaches

Fatigue in chronic liver disease: New insights and therapeutic approaches

Complications, symptoms, quality of life and pregnancy in cholestatic liver disease

Primary Biliary Cholangitis

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