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Fatigue in primary biliary cirrhosis
  1. D M Forton1,
  2. N Patel2,
  3. A Oatridge2,
  4. G Hamilton2,
  5. J V Hajnal2,
  6. H C Thomas3,
  7. S D Taylor-Robinson3,
  8. M Prince4,
  9. J Goldblatt4,
  10. M Bassendine4,
  11. D E J Jones4
  1. 1Liver Unit, Faculty of Medicine, St Mary’s Hospital Campus, Imperial College London, London, UK
  2. 2Robert Steiner MR Unit, MRC Clinical Sciences Centre, Hammersmith Hospital Campus, Imperial College London, London, UK
  3. 3Liver Unit, Imperial College London
  4. 4Centre for Liver Research, University of Newcastle, Newcastle, UK
  1. Correspondence to:
    D M Forton
    Hepatology Section, Faculty of Medicine, Imperial College London at St Mary’s Hospital, 10th floor QEQM Building, South Wharf Rd, London W2 1NY, UK;

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We would like to take the opportunity to clarify some of the points in response to the recent leading article (Gut 2004;53:475–7) which accompanied our report1 of reduced globus pallidus (GP) magnetisation ratios (MTRs) in patients with fatigue and primary biliary cirrhosis (PBC).

As we stated in the paper, fatigue in PBC is a subjective multidimensional symptom with many potential determinants, including sleep disturbance, depression, and personality, in addition to a potential central neurological cause.1 We therefore wholeheartedly concur with Drs Milkiewicz and Heathcote when they state that brain manganese (Mn) deposition is certainly not the cause of fatigue in all patients with PBC. We certainly do not believe that we drew this conclusion. However, we do believe that our findings of reduced GP MTRs in patients with stage I–II disease, which were associated with hypermanganesaemia and measured fatigue, do open up a novel avenue of research into a poorly understood symptom in patients with PBC.

In order …

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