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Martins, Renato Duffles; Szejnfeld, Jacob; Lima, Flávio G.; Ferrari, Ângelo Paulo

doi:10.1023/a:1005501930808

Cited by 22 publications

(3 citation statements)

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“…We identified advanced periportal fibrosis, large varices, ascites, and jaundice as independent predictors of UGIB. Others have reported similar findings [ 14 , 23 , 33 – 35 ]. Our results also showed individuals with a close family member with HS were more likely to experience more episodes of UGIB.…”

Section: Discussionsupporting

confidence: 76%

“…PZQ has also been shown to decrease portal vein diameter and to reduce the prevalence of esophageal varices [ 3 – 8 ]. Predictors of successful treatment of periportal fibrosis following PZQ use include female gender, young age, mild-to-moderate periportal fibrosis, hepatitis B surface antigen-negative status, low S. mansoni re-infection rates, and genetics or family pedigree [ 9 – 14 ].Whereas PZQ is considered very safe, over the last 15 years, a number of drug safety concerns have emerged [ 2 , 7 ]. Most of these have been highlighted in a number of reports from clinical studies, anthropological studies, and drug information leaflets [ 5 , 15 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Praziquantel and Upper Gastrointestinal Bleeding in Hepatic Schistosomiasis: A Quasi-Experimental Study

Opio

Kazibwe

Kabatereine

et al. 2020

Drugs - Real World Outcomes

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Background There is a general consensus that widespread use of praziquantel in populations where schistosomiasis is endemic prevents development of hepatic schistosomiasis and its complications. However, a few studies have reported discordant findings linking praziquantel to the occurrence of upper gastrointestinal bleeding (UGIB) in some patients with hepatic schistosomiasis and varices. Objective We explored if there was any causal association between recent praziquantel use (rPZQ) and upper gastrointestinal bleeding in hepatic schistosomiasis in rural Africa. Patients and Methods A quasi-experimental, retrospective case-controlled study was performed. It involved adult patients with past or acute UGIB, varices, periportal fibrosis, and/or cirrhosis. Cases had acute variceal bleeding while controls did not. The outcome was the frequency of lifetime episodes of UGIB and exposure was rPZQ (received praziquantel in the last 11 months from the date of enrollment). The data analysis included 2 × 2 tables, logistic regression, and propensity-score matching. Odds ratios (ORs), average treatment effects (ATEs), and their 95% confidence intervals (CIs) were used for inference. Results Over 6 weeks, we enrolled 19 cases with 92 lifetime episodes of UGIB, and 66 controls with 192 lifetime episodes of UGIB. Cases were more likely to experience UGIB than controls following rPZQ (92% vs. 62%; OR 7.6; 95% CI 3.4–17). Factors predictive of more lifetime episodes of UGIB at multivariable analysis included rPZQ (adjusted OR 13; 95% CI 2.9–53), relative leukocytosis (adjusted OR 26; 95% CI 7.6–89), large varices (adjusted OR 5.0; 95% CI 1.7–15), a family member with hepatosplenic schistosomiasis (adjusted OR 19; 95% CI 7.4–51), advanced periportal fibrosis (adjusted OR 8.0; 95% CI 2.6–22), ascites (adjusted OR 14; 95% CI 4.3–47), and jaundice (adjusted OR 32; 95% CI 7.8–128). While the ATE following rPZQ among the treated was 0.40 (95% CI 0.33–0.48). Conclusions Our findings suggest the presence of a plausible causal association between recent praziquantel use and increased frequency of UGIB in our study population. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-020-00222-7.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Praziquantel and Upper Gastrointestinal Bleeding in Hepatic Schistosomiasis: A Quasi-Experimental Study

Opio

Kazibwe

Kabatereine

et al. 2020

Drugs - Real World Outcomes

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“…[6] The parameters associated with variceal bleeding in patients with hepatosplenic schistosomiasis are endoscopic (variceal size, red signs, congestive gastropathy and fundic varices) and ultrasonographic (portal vein diameter and periportal thickness). [7] However, there are no consistent noninvasive parameters for the diagnosis of esophageal varices in this specific patient population.…”

mentioning

confidence: 99%

Use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with schistosomiasis

Agha

Abdulhadi

Marenco

et al. 2011

Saudi J Gastroenterol

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Background/Aim:In patients with liver cirrhosis, the platelet count/spleen diameter ratio has been validated as a parameter for the noninvasive diagnosis of esophageal varices. Schistosoma infection is a frequent cause of portal hypertension in Middle Eastern countries, and is associated with the development of esophageal varices. In this study we aimed to evaluate the platelet count/spleen diameter ratio as a noninvasive tool for the prediction of the presence of esophageal varices in patients with schistosoma-related chronic liver disease.Patients and Methods:Forty-three patients with hepatosplenic schistosomiasis underwent upper digestive endoscopy to check for the presence of esophageal varices. Furthermore, all patients underwent abdominal ultrasonography, and maximum spleen diameter (in mm) was measured. The platelet count/spleen diameter ratio was calculated in all patients.Results:Esophageal varices were found in 31 patients (72%). Age and gender were not significantly different between patients with and without varices. In patients with varices, median platelet count (82,000/μL versus 172,000/μL, P < 0.0001) and platelet count/spleen diameter ratio (571 versus 1651, P < 0.0001) were significantly lower, while spleen diameter (147 mm versus 109 mm, P = 0.0006) was significantly larger. In multivariate analysis, the platelet count/spleen diameter ratio was the only parameter independently associated with the presence of varices (P < 0.0001).Conclusions:In this study we have validated the use of the platelet count/spleen diameter ratio for the noninvasive diagnosis of esophageal varices in patients with portal hypertension caused by schistosoma infection. In these patients, the platelet count/spleen diameter ratio might be used to allow better rationalization of medical resources and use of endoscopy.

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