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Chronic Fatigue Syndrome

Chronic Fatigue in Patients with Liver Disease

JN Plevris, JA Cossar"^({*})", MM Dollinger, IAD Bouchier, RE O'Carroll (*), PC Hayes. Liver Research Laboratories University Department of Medicine and Clinical Psychology (*), The Royal Infirmary Edinburgh EH3 9YW.

Introduction:
Chronic fatigue is common in patients with chronic liver disease, particularly cholestatic, sometimes of a severity markedly out of proportion to liver dysfunction. However systematic studies on this debilitated symptom are rare.

Aim:
To study the distribution, severity and possible associations of chronic fatigue in a cohort of patients with chronic liver disease of various aetiologies. Methodology: In 30 patients with liver cirrhosis (19 female, 11 male, age 25-68 yrs, Childs A=4, B=12, C=14) of various aetiologies (PBC= 10, Alcohol= 8, viral= 3, sclerosing cholangitis=3, autoimmune chronic active hepatitis= 2, other= 4) the Bentall mental fatigue score was measured and correlated with clinical and biochemical parameters of liver disease. 30 normal controls of a similar age range had the Bentall score measured.

Results:
Bentall score was 3.5±0.4 (mean±SEM) for controls. 26/30 (86.8%) of patients had a mental fatigue score >mean+2SEM of controls; 11/30 patients scored >15, 5/30 between 10-15 and 10/30 between 5-9. No significant difference in the mean Bentall score was found between males and females, across aetiologies or with the severity of liver disease (Childs score) even after correction for anaemia, age, body mass index (BMI) and renal function. No correlation was found between Bentall score and liver function tests, haemoglobin, prothrombin time or nutritional status (BMI, albumin).

Conclusion:
Chronic fatigue results from an altered (probably centrally mediated) homeostatic mechanism which is deranged independent of the severity and aetiology of liver disease. This mechanism is poorly understood and requires further study.

Hepatitis C can damage the brain, say scientists

Tens of thousands of people may be suffering depression, memory loss and chronic tiredness because they are unknowingly infected with hepatitis C. For the first time, British scientists have shown that the blood-borne virus can cause abnormalities in the brain as well as trigger liver damage.

The symptoms are almost identical to those of chronic fatigue syndrome, or ME, although the team involved in the finding believes the two conditions are unrelated.

The British Liver Trust said the findings helped to solve a long-running puzzle about the disease. Up to 400,000 people are infected with hepatitis C in Britain, many of them through blood transfusions before screening was introduced in 1991.

The virus can also be transmitted sexually or by dirty needles and can cause liver disease and liver cancer. There are often no warning signs until damage is far advanced and many people are unaware they are infected.

Although patients with the virus complain of impaired memory, fatigue and an inability to function well, doctors say the symptoms are unrelated to the virus.

Researchers led by Professor Howard Thomas at Imperial College Medical School, London, have now shown that the virus can cause mental impairments.

Using a type of scan known as magnetic resonance spectroscopy, they looked at the balance of two proteins, choline and creatine, in the brains of patients with hepatitis C, people with hepatitis B and a healthy control group.

Those with hepatitis C had a higher choline to creatine ratio in parts of the brain, they report in the The Lancet. The ratio is known to go up if regions of the brain are infected or inflamed.

Similar changes in brain chemistry are found in HIV patients who suffer similar mental impairment. There was no difference between drug users and non-drug users, the team from Imperial College and Hammersmith Hospital in London found.

Professor Thomas said that patients with hepatitis C often complained of symptoms similar to those of ME. The study suggests either that the virus is directly responsible within the brain for the impairments, or they are caused by chemicals from an infected liver.

Evidence for a cerebral effect of the hepatitis C virus.

Lancet 2001 Jul 7;358(9275):38-9BooksForton DM, Allsop JM, Main J, Foster GR, Thomas HC, Taylor-Robinson SD.
Hepatology Section, Division of Medicine, Imperial College School of 
Medicine, St Mary's Hospital, London, UK

Patients with hepatitis C virus (HCV) infection frequently complain of  symptoms akin to the chronic fatigue syndrome and score worse on  health-related quality of life indices than matched controls. We address the hypothesis that HCV itself affects cerebral function. Using proton magnetic-resonance spectroscopy we have shown elevations in basal ganglia and white matter choline/creatine ratios in patients with 
histologically-mild hepatitis C, compared with healthy volunteers and patients with hepatitis B. This elevation is unrelated to hepatic encephalopathy or a history of intravenous drug abuse, and suggests that a biological process underlies the extrahepatic symptoms in chronic HCV infection.