LEADING ARTICLE

Fatigue in chronic cholestasis

P Milkiewicz¹, E J Heathcote²

¹ Department of Gastroenterology, Pomeranian Medical School, 71-242 Szczecin, Unii Lubelskiej 1, Poland, and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
² Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada

Correspondence to:
Correspondence to:
Dr E J Heathcote
Toronto Western Hospital, University Health Network, 399 Bathurst St, 6B Fell Pavilon, Room 172, Toronto, Ontario M5T 2S8, Canada; jenny.heathcote{at}utoronto.ca

Fatigue is probably the most intriguing symptom affecting patients with chronic cholestatic disorders, in particular those with primary biliary cirrhosis. It is postulated that fatigue in patients with primary biliary cirrhosis may be associated with morphological abnormalities of the central nervous system secondary to accumulation of manganese. However, we are still far from understanding this complex issue.

Keywords: fatigue; cholestasis; primary biliary cirrhosis; magnetisation transfer ratio; manganese

Abbreviations: SLE, systemic lupus erythematosus; PBC, primary biliary cirrhosis; Mn, manganese; ¹H MRS, proton magnetic resonance spectroscopy; MTR, magnetisation transfer ratio; PSE, portosystemic encephalopathy; CNS, central nervous system; GP, globus pallidus

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