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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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