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

Abstract

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,

Report of the Second Satellite Symposium on Ultrasound in Schistosomiasis

“…It was therefore felt that this measurement including the assessment of respiration variation is recommended in hospitalized patients but was less useful in the field. The Niamey-Belo Horizonte Portal Hypertension score was found to reflect more the clinical status of four Senegalese patients with complicated periportal fibrosis than other scores tested in the past (Abdel-Wahab et al 1993, Richter et al 1998). …”

Liver fibrosis: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)

“…An ultrasonographic scoring system grading periportal fibrosis, portal vein diameter, spleen size, and portosystemic anastomoses was evaluated as a predictor of esophageal varices and proved useful in predicting the presence of esophageal varices [30].…”

Imaging techniques and histology in the evaluation of liver fibrosis in hepatosplenic schistosomiasis mansoni in Brazil: a comparative study

“…The development of portable US devices is considered an advance in the investigation of morbidity in field-based studies (Marinho et al 2006). US may also be used to evaluate the dynamic changes produced by portal hypertension and, accordingly, may suggest the presence of oesophageal varices (Abdel-Latif et al 1981, Davidson et al 1991, Abdel-Wahab et al 1993, Richter et al 1998). However, this diagnostic tool requires well-trained physicians and its standardization is still a matter of debate after two World Health Organization (WHO) workshops (Cairo Working Group 1992, Niamey Working Group 1996, Lambertucci et al 2001.…”