Fatigue In Liver Disease Research Articles

Pruritus and fatigue associated with liver disease: is there a role for ondansetron?

Background: Complications of liver disease include pruritus and fatigue. Increased central opioidergic tone, which is modulated by serotoninergic pathways, contributes to the former; increased central serotoninergic tone may contribute to the latter. Objective: To examine non-clinical and clinical data relevant to the hypothesis that ondansetron, a 5-HT3 receptor subtype antagonist, ameliorates pruritus and fatigue in liver disease. Methods: Non-clinical findings supporting the hypothesis are discussed and all trials of ondansetron for pruritus or fatigue in liver disease are reviewed. Conclusion: That ondansetron ameliorates pruritus in liver disease is strongly supported by subjective observations, but is not confirmed by objective findings in two controlled trials. Anecdotal observations also suggest that ondansetron ameliorates fatigue in liver disease, but in only one of two randomized controlled trials, that used subjective end points, is a similar conclusion possible.

Aerobic exercise: a potential therapeutic intervention for patients with liver disease

Fatigue is a symptom of liver disease. Indirect evidence suggests that this type of fatigue is centrally mediated. Non-alcoholic steatohepatitis (NASH), which may lead to cirrhosis, is associated with insulin resistance. An activated hypothalamic pituitary adrenal axis results in increased secretion of cortisol releasing hormone, cortisol and catecholamines. Prolonged exposure to high levels of cortisol is associated with insulin resistance, as exemplified by the metabolic syndrome. Accumulation in visceral fat is an independent factor associated with insulin resistance. Central (visceral) fat is less sensitive to insulin than the rest of body fat and the central nervous system and not peripheral insulin, appears to regulate lipolysis in visceral fat by, at least in part, adrenergic mechanisms. Aerobic training has documented beneficial effects on mental health and fatigue secondary to chronic illness. In addition, aerobic training increases insulin sensitivity. Thus, aerobic training may decrease fatigue in liver disease and improve NASH.