Oesophageal varices in a region of the Sudan endemic for <i>Schistosoma mansoni</i>

Saad, Ahmed; Hassan, Medhat M.; Homeida, M.; Eltom, I; Nash, Theodore E.; Bennett, J.L.

doi:10.1002/bjs.1800781033

Cited by 34 publications

(24 citation statements)

References 11 publications

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“…Thus, prognostic indicators for the identification of patients at risk of variceal bleeding are urgently needed. The endoscopically determined variceal grade is the only parameter so far applied, although this has never been validated prospectively in schistosomiasis (Saad et al 1991, El-Sheikh Mohamed AR et al 1994Eltoum et al 1994). The pivotal importance of research on the value of sonography in this respect has recently been recognized by an expert committee convened by the World Health Organization in Niamey.…”

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%

“…So far, the only method suitable for the prediction of variceal haemorrhage in patients with periportal fibrosis has been endoscopy (Saad et al 1991). In endemic regions, though, endoscopy is frequently not available or limited to wellequipped hospitals of urban centres.…”

Section: Clinical Examination Endoscopy and Sonographymentioning

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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“…In the Gezira area, we estimated that 12,000-15,000 persons have bleeding esophageal varices secondary to schistosomal fibrosis, some of which required immediate medical attention. 6 Adding to this, a mortality rate of 51/100,000/year in the general population and 1/1,000/year in adult males shows the impact of schistosomiasis on public health in this economically important region of Sudan.…”

Section: Discussionmentioning

confidence: 94%

“…4 The presence and grade of esophageal varices was recorded in all subjects found to have schistosomal periportal fibrosis, as previously reported. 6 Because the level of infection was very high, we treated all inhabitants present at the first survey with praziquantel (Biltricide; Bayer AG, Leverkusen, Germany) in a single oral dose of 40 mg /kg. Following mass chemotherapy, only 28 subjects were treated between the surveys.…”

Section: Study Plan Subjects and Methodsmentioning

confidence: 99%

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Mortality due to schistosomiasis mansoni: a field study in Sudan.

Kheir¹,

Eltoum²,

Saad³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Although schistosomiasis affects 200 million persons, 20 million of whom have advanced disease, little is known about the mortality pattern in areas of endemic schistosomiasis mansoni. In an attempt to assess the mortality rates in an endemic area in Sudan, we conducted two demographic surveys in a village in the Gezira area. Clinical, sonographic, and parasitologic examinations were performed in a randomly selected sample of 25% of the population in 1987 and 1994. One of us asked each head of household about the names, sex, and age of family members. Particularly, we asked about death in the family if any, history of schistosomiasis, abdominal swelling, and hematemesis. Possible causes of death were ascertained by reviewing medical records in the village dispensary and the district hospital. There were 42 deaths in the village. Four males died of hematemesis secondary to portal fibrosis. The crude mortality rate of schistosomiasis was is 51/100,000/year. The overall schistosomiasis fatality rate per year was 1/1,000 infected persons, but was as high as 11/100/infected patients with bleeding varices. These findings showed the impact of schistosomiasis on public health in this economically important region of Sudan.

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