Gastrointestinal Manifestations of Autonomic Dysfunction in Cirrhosis

Pathophysiological Mechanisms

The autonomic dysfunction favors intestinal bacterial overgrowth and bacterial translocation by deteriorating intestinal motility, which is a key pathophysiological mechanism in patients with cirrhosis 1
The relative adrenal insufficiency (present in 41.8% of non-critical cirrhotic patients and 68.9% with sepsis) attenuates the vascular effect of angiotensina II, norepinephrine, and vasopressin, worsening circulatory dysfunction and favoring intestinal bacterial overgrowth in patients with cirrhosis 1
The autonomic dysfunction is associated with a higher probability of severe sepsis, type 1 hepatorenal syndrome, and higher short-term mortality in patients with cirrhosis 1

The gastric emptying scintigraphy with solid radiolabeled food for 4 hours is the diagnostic standard, considering abnormal a retention >50% at 100 minutes, according to the American Gastroenterological Association 2
The 13C-octanoate breath test is a non-radioactive alternative that correlates well with scintigraphy, as recommended by the American Gastroenterological Association 2