Diagnosis of Pathologically Confirmed Symmers' Periportal Fibrosis by Ultrasonography: A Prospective Blinded Study

Homeida, M.; Abdel-Gadir, Abdel Fatah; Cheever, Allen W.; Bennett, James L.; Arbab, Bashir M. Osman; Ibrahium, Shaikir Z.; Abdel-Salam, Isam M.; Dafalla, A.A.; Nash, Theodore E.

doi:10.4269/ajtmh.1988.38.86

Cited by 140 publications

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“…endoscopic and sonographic findings and variceal bleeding were compared had conflicting results: whereas in earlier studies a relationship between the sonographic grade of periportal fibrosis, the occurrence of variceal haemorrhage prior to examination and/or the grade of oesophageal varices had not been found (Homeida et al 1988;Davidson et al 1991), more recent investigations showed that the sonographic grade of periportal fibrosis is related to prior variceal haemorrhage (Richter et al 1992a;Domingues et al 1993;Abdel-Wahab et al 1993;Eltoum et al 1994;Gerspacher-Lara et al 1997).…”

Section: Discussionmentioning

confidence: 99%

“…For the latter classification, DoehringSchwerdtfeger et al (1992) have shown that whereas interobserver variance may influence the grading of incipient fibrosis, this is unlikely to happen in the more advanced stages, where variceal bleeding occurs. At a recent meeting in Niamey it has been recognized that the reproducibility of the grading of fibrosis whichever classification had been applied so far, may be limited by several subjective and objective factors (Homeida et al 1988;Doehring-Schwerdtfeger et al 1989;Richter et al 1992a. This applies particularly to the 'Cairo' methodology and a similar methodology used by AbdelWahab et al (1993) which are based on the measurement of the external diameter of portal branches because it is not clearly defined where to measure.…”

Section: Discussionmentioning

confidence: 99%

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Sonographic prediction of variceal bleeding in patients with liver fibrosis due to Schistosoma mansoni

Richter

Dacal²,

Siqueira

et al. 1998

Tropical Med Int Health

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SummarySeveral studies have shown that the characteristic hepatic abnormalities induced by Schistosoma mansoni detectable by ultrasound correlate with the degree of oesophageal varices. So far the value of ultrasound for predicting variceal haemorrhage has not been assessed. Fifty Brazilian patients with schistosomal periportal fibrosis from Alagoas State, 18 of whom had already bled from oesophageal varices, were enrolled in a combined cross-sectional and longitudinal study and investigated clinically, by endoscopy and by ultrasound. Twenty-seven of the patients were monitored until another bleeding episode, death or for a minimum of 28 months. Eight of these patients could be followed up for a further three years. A sonographic score, which accounts for the degree of echogenic periportal thickening and of portal vein dilatation, was calculated for all patients. A highly significant correlation (P Ͻ 0.0001) existed between the sonographic score and the occurrence of previous variceal haemorrhage, paralleled by a similar correlation between the sonographic score and the degree of oesophageal varices (P Ͻ 0.001). In the 27 patients monitored longitudinally, the sonographic score indicated the risk of future variceal bleeding (P Ͻ 0.0001). The sonographic score reliably predicts the risk of variceal bleeding in individual patients with periportal fibrosis. Hence, the application of endoscopy, if available at all in endemic areas, may be restricted to the patients at risk of future variceal bleeding, as determined by ultrasound. Since portable devices can be carried even to remote areas, the application of the proposed score in community surveys could provide a new means for the identification of high-risk patients in S. mansoni-infected populations.keywords S. mansoni, hepatic abnormalities, oesophageal varices, ultrasound correspondence Joachim Richter,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sonographic prediction of variceal bleeding in patients with liver fibrosis due to Schistosoma mansoni

Richter

Dacal²,

Siqueira

et al. 1998

Tropical Med Int Health

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“…Previous studies have correlated periportal fibrosis measured by ultrasound with biopsyproven liver pathology in individuals infected by S. mansoni (HOMEIDA et al, 1988;DOEHRING-SCHWERDTFEGER er aZ., 1989). In this study we could not perform liver biopsies.…”

Section: Discussionmentioning

confidence: 99%

“…Decreases in the thickness of portal vein walls and in echogenic bands have been detected after praziquantel therapy (HOMEIDA et al, 1988;DOEHRING-SCHWERDTFEGER et al, 1989: OH-MAE et al, 1992WIEST et al, 1993;CAI>~ al., i997;GERSPACHER-LARA et aI, 1997;BOISIER et al, 1998). Assay of serum levels of fibrosis markers may be a useful supplementary tool for monitoring changes in liver fibrosis (SHAHIN et aZ., 1992;KARDORFF et al, 1997;OBERTI et al, 1997;ESTERRE et al, 1998;RICARD-BLUM et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Two-year impact of praziquantel treatment for Schistosoma japonicum infection in China: re-infection, subclinical disease and fibrosis marker measurements

Sleigh

Ross

et al. 2000

Transactions of the Royal Society of Tropical Medicine and Hygi

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We studied a community cohort of 193 individuals exposed to endemic Schistosoma japonicum infection in the Dongting Lake region of China to assess subclinical morbidity and the 2-year benefit of curative therapy (praziquantel) administered in 1996. Prevalence and intensity of S. juponicum infection before treatment were 28% and 192 eggs per gram faeces (epg), respectively. Two years after cure, 22% of the cohort were reinfected, but with a lighter intensity (67 epg). Sixty-four subjects (37%) showed significant improvement in ultrasound parenchyma images after treatment and 5 1 subjects (54%) showed significant improvement of periportal fibrosis, Left-lobe enlargement also reversed (P < 0.05) and splenomegaly reversed in 6 of 8 cases and developed in only I. Two years post-treatment a dilated portal vein became less frequent, but the decline was not significant (16% vs 1 1 %, P > 0.05). The serum levels of laminin and collagen IV associated with reinfection and intensity and hyaluronic acid levels correlated with ultrasound findings (P < 0.01). Overall, treatment induced a marked decrease in subclinical hepatosplenic morbidity attributable to S. japonicum although low-intensity re-infection after treatment remained relatively frequent. Stratified analysis and logistic models evaluated potential confounding factors for assessment of treatment effects on hepatic fibrosis. S. juponicum infection and moderate-heavy alcohol intake interacted: improvement in parenchymal morbidity was impeded among drinkers (P < 0.05). Chemotherapy focused on at-risk residents controls prevalent subclinical hepatic fibrosis but re-infection indicates the need for complementary control strategies.

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“…2001). Most studies have reported decreases in portal vein 'enlargement and in echogenic bands after effective treatment (HOMEIDA et al, 1988;DOEHRING et al, 1989;MOTT et al, 1992;WIE~T et al, 1993;BOISIER et al, 1998;LI et al, 2000aLI et al, . 2000b.…”

Section: Introductionmentioning

confidence: 99%

Five-year impact of repeated praziquantel treatment on subclinical morbidity due to Schistosoma japonicum in China

Sleigh

et al. 2002

Transactions of the Royal Society of Tropical Medicine and Hygi

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We report the 5-year impact (1996)(1997)(1998)(1999)(2000)(2001) of repeated praziquantel chemotherapy on subclinical morbidity related to Schistosoma japonicum infection. We repeated stool examinations and hepatosplenic ultrasonography in a cohort of 120 individuals living on an island with endemic infection in Dongting Lake, China. Prevalence of schistosome infection fell by 43% and intensity (geometric mean eggs per gram) declined by 80% over the 5 years. However, transmission persisted at a dangerously high rate of 13% per year for re-infection or new infection in the cohort. The prevalence of left-lobe enlargement and dilated portal vein fell significantly (P < 0.01) to about half initial levels although a few patients progressed during the study period. At study endpoint, infection was nearly twice as common if the portal vein was dilated (23% versus 13%, respectively), but this association was not statistically significant (P > 0.05). However, endpoint infection was even more strongly associated with left-lobe enlargement (57% versus 15%, P < 0.01). The proportions of subjects with improved parenchymal and periportal tibrosis were much higher than the proportions of subjects that progressed (P < 0.05). Reduction of prevalence and intensity of infection, and improvement of subclinical morbidity, were benefits of repeated treatments. Further research is needed to understand why some patients developed fibrosis despite substantial reductions in egg counts and to evaluate the functional importance of residual subclinical morbidity after chemotherapy-based control in the lake and marshland area of China.

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Diagnosis of Pathologically Confirmed Symmers' Periportal Fibrosis by Ultrasonography: A Prospective Blinded Study

Cited by 140 publications

References 0 publications

Sonographic prediction of variceal bleeding in patients with liver fibrosis due to Schistosoma mansoni

Sonographic prediction of variceal bleeding in patients with liver fibrosis due to Schistosoma mansoni

Two-year impact of praziquantel treatment for Schistosoma japonicum infection in China: re-infection, subclinical disease and fibrosis marker measurements

Five-year impact of repeated praziquantel treatment on subclinical morbidity due to Schistosoma japonicum in China

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