Background: The betablockers combined with endoscopic variceal band ligation (EVL) is the most effective prevention of variceal rebleeding. The aim of this study is to evaluate the efficacy and safety of carvedilol compared to propranolol as secondary prevention of variceal bleeding in hepatic schistosomiasis. Methods: All patients with portal hypertension due to schistosomiasis presenting for EVL with at least one episode of variceal bleeding were included and randomized into propranolol + EVL and Carvedilol + EVL groups. Results: Sixty-one patients were selected and randomized into the propranolol group (n=30) and carvedilol group (n=31). We noted less recurrence of bleeding in the carvedilol group (n=1) than in the propranolol group (n=3) (3.33% vs 10%; p=0.30). Bleeding recurrence occurred after 30 days in the carvedilol group and after 5, 45 and 90 days in the propranolol group. At 4 months, a significant reduction in mean arterial pressure (-4.13 mmHg; 95%CI: -6.27 and -1.99; p <0.05) and heart rate (-12.13 mmHg; 95%CI: -13.92 and -10.35; p<0.05) was found in the carvedilol group. There was no significant difference between the two groups on the mean difference in mean arterial pressure. A patient in the carvedilol group presented breathing difficulty. No adverse effects have been demonstrated in the propranolol group. Conclusion: Carvedilol is as effective as propranolol in the prevention of variceal rebleeding in hepatic schistosomiasis.

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It is essential to differentiate intestinal tuberculosis from Crohn's disease because of the therapeutic implications of Crohn's disease, which can exacerbate the symptoms of tuberculosis.

Background: Spontaneous bacterial peritonitis (SBP) represent frequent and serious complications in cirrhosis patients with ascites. Our aim was to describe the clinical and bacteriological characteristics of SBP in Madagascar.Methods: This is a 21-month prospective study between January 2018 and October 2019, including hospitalized patients with cirrhosis, with clinical and biological symptoms of SBP.Results: Thirty-three patients were included. The mean age was 48.09 ± 13.55 years (extremes: 19 – 78 years), the sex ratio was 3.12. Abdominal pain (55%), fever (36%), diarrhea (6%), hepatic encephalopathy (18%) are the most common symptoms. Gastrointestinal bleeding (18.18%) was the main risk factor to SBP. SBP was community-acquired in 87.88% of cases. A culture of ascites fluid was positive for 9 patients (27.27%). The infectious agents found were Escherichia coli (12.10%), Klebsiella pneumoniae (3%), Pseudomonas (3%), Streptococcus mitis (9.1%). Escherichia coli were wild with one case resistant to Ceftriaxone. The Klebsiella were multidrug resistant. The other two pathogens did not show resistance. After antibiotic therapy adapted to the antibiogram, healing was observed in 26 patients (78.78%). Seven patients (21.22%) died from various complications. All deceased patients had bacteria identified in ascites fluid.Conclusion: SBP defined according to clinical and biological criteria is apparently sterile in the majority of cases. Gram-negative bacteria were the major pathogens involved in SBP in cirrhotic patients. Escherichia coli and streptococcus were the most common pathogen isolated. Bacteriological study is essential to adapt antimicrobial to multidrug-resistant bacteria.

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