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Fatigue in chronic liver disease: New insights and therapeutic approaches

Lookup NU author(s): Professor David Jones

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Abstract

© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 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.

Publication metadata

Author(s): Swain MG, Jones DEJ

Publication type: Article

Publication status: Published

Journal: Liver International

Year: 2019

Volume: 39

Issue: 1

Pages: 6-19

Print publication date: 01/01/2019

Online publication date: 23/06/2018

Acceptance date: 20/06/2018

ISSN (print): 1478-3223

ISSN (electronic): 1478-3231

Publisher: Wiley-Blackwell Publishing Ltd.

URL: https://doi.org/10.1111/liv.13919

DOI: 10.1111/liv.13919

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