Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding

Abstract

-Background -Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson's schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. Aims -To evaluate duplex sonography findings in patients with hepatosplenic Manson's schistosomiasis with and without upper gastrointestinal variceal hemorrhage. Methods -A cross-sectional study was performed whereby 27 consecutive patients with hepatosplenic Manson's schistosomiasis were divided into two groups: group I (six men and six women; mean age 48.7 years) with a past history of bleeding and group II (four men and eight women; mean age 44.7 years) without a past history of upper gastrointestinal bleeding, underwent duplex sonography examination. All patients underwent the same upper gastrointestinal endoscopy and laboratory examinations. Those with signs of mixed chronic liver disease or portal vein thrombosis (three cases) were excluded. Results -Group I showed significantly higher mean portal vein flow velocity than group II (26.36 cm/s vs 17.15 cm/sec). Although, as a whole it was not significant in all forms of collateral vessels (83% vs 100%), there was a significantly higher frequency of splenorenal collateral circulation type in group II compared with group I (17% vs 67%). The congestion index of the portal vein was significantly lower in group I than in group II (0.057 cm vs 0.073 cm/sec). Conclusion -Our duplex sonography findings in hepatosplenic Manson's schistosomiasis support the idea that schistosomotic portal hypertension is strongly influenced by overflow status, and that collateral circulation seems to play an important role in hemodynamic behavior.

Polyphenol‐rich Mango (Mangifera indica L.) Ameliorate Functional Constipation Symptoms in Humans beyond Equivalent Amount of Fiber

“…Nondigestible carbohydrates cannot be metabolized by digestive enzymes and therefore are not considered a source of energy to humans. However, these compounds can be fermented by certain commensal intestinal microbes into short‐chain fatty acids (SCFA) . The anti‐inflammatory effects of SCFA such as butyrate and propionate have been previously described …”

Increased Hepatic Arterial Blood Flow Measured by Hepatic Perfusion Index in Hepatosplenic Schistosomiasis: New Concepts for an Old Disease

“…Razzak [17], by calculating the hepatic uptake of radioactive gold Au-198m, suggested that hepatic blood flow was reduced in patients with HSS, and this reduction was related to the severity of liver disease. However, these data contradict current knowledge based on experimental, ultrasound and hemodynamic studies that, despite presence of liver fibrosis and portal hypertension, show normal total liver flow in schistosomiasis [26][27][28][29]. Other scintigraphic studies in HSS population were restricted to morphological features, such as those of Iio et al [19] and Mustafa et al [18], which showed lower liver uptake of radioactive gold, atrophy of right hepatic lobe, irregular liver surface, and increased splenic uptake of radiotracer.…”

Characterization of portal hypertension in hepatosplenic schistosoma mansoni patients using B-mode ultrasound

“…In addition, besides the lack or reduced respiratory variations of the SV, there was an impressive increase in the SV width; the SV width in patients with PH was twice the width measured in the control group ( Figure 5). Several studies have shown that SV as well as spleen size is statistically different in the control and patients affected with Schistosoma mansoni (Arruda, Barreto, & Amaral, 2008;Maia et al, 2007;Malenganisho et al, 2008;Thomas et al, 1997). Portosystemic collaterals form when the resistance to blood stream in the portal vessels exceeds the resistance to flow in the small communicating channels between the portal and systemic circulations.…”