Prevalence of gastric varices and portal hypertensive gastropathy in patients with Symmers periportal fibrosis

Mudawi, Hatim; Ali, Y.; Tahir, Mohamed El

doi:10.4103/0256-4947.51764

Cited by 5 publications

(6 citation statements)

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“…The changes caused by portal hypertension are among the leading causes of morbidity and mortality in patients with schistosomiasis [25]. Formation of portal-systemic collateral circulation and increased portal and splenic vein diameter are the main changes occurring in the portal venous system of patients with schistosomiasis [1], [26].…”

Section: Discussionmentioning

confidence: 99%

Intrapulmonary Vascular Dilatation Evaluated by 99mTc-MAA Scintigraphy and Its Association with Portal Hypertension in Schistosomiasis

et al. 2014

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BackgroundPortal hypertension is responsible for various complications in patients with schistosomiasis, among them intrapulmonary vascular dilations (IPVD). In cirrhotic patients the presence of IPVD is a sign of poor prognosis, but in patients with hepatosplenic schistosomiasis (HSS) there are no studies assessing the significance of this change. The aim of this study was to evaluate the occurrence of IPVD through 99mTc-MAA scintigraphy in patients with HSS and its relationship with clinical, laboratory, endoscopic and ultrasound parameters.MethodsCross-sectional study evaluating 51 patients with HSS. Patients were diagnosed with IPVD when the brain uptake of 99mTc-MAA was higher than 6%. Subsequently, they were divided according to presence (G1) or absence (G2) of IPVD and variables were compared between groups.ResultsOverall, 51 patients with mean age of 56±12 years were assessed. IPVD was observed in 31 patients (60%). There was no statistically significant differences between groups when clinical, laboratory and endoscopic parameters were compared. Regarding ultrasound parameters, the splenic vein diameter was smaller in G1 (0.9±0.3 cm) compared to G2 (1.2±0.4 cm), p = 0.029.ConclusionIn patients with HSS, the occurrence of IPVD by 99mTc-MAA scintigraphy was high and was associated with lower splenic vein diameter, which can be a mechanism of vascular protection against portal hypertension. However, more studies are needed to determine the clinical significance of the early diagnosis and natural evolution of IPVD in this population.

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Section: Discussionmentioning

confidence: 99%

Intrapulmonary Vascular Dilatation Evaluated by 99mTc-MAA Scintigraphy and Its Association with Portal Hypertension in Schistosomiasis

et al. 2014

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“…Gastric varices and portal hypertensive gastropathy seem to have a lower prevalence in patients with Symmers periportal fibrosis compared with patients with cirrhosis or NCPF. 129 Hemodynamic studies show 2 stages in the development of portal hypertension. In the early stage, the portal venous pressure is raised, but WHVP is normal indicating a presinusoidal block resulting from obstruction of portal venules by eggs and granulomatous reaction.…”

Section: Hepatic Schistosomiasismentioning

confidence: 99%

Intrahepatic Portal Venopathy and Related Disorders of the Liver

Chawla

Dhiman

2008

Semin Liver Dis

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Intrahepatic portal venopathy leads to various entities that are important causes of portal hypertension. Noncirrhotic portal fibrosis (NCPF) occurs in the Indian subcontinent, whereas idiopathic portal hypertension (IPH) occurs in Japan although the pathogenesis and presentation of both are similar. NCPF presents mainly with upper gastrointestinal bleeding; IPH presents with massive splenomegaly. The liver functions are preserved. Wedged hepatic venous pressure is normal, but portal venous pressure is high indicating a presinusoidal block. Patients are best managed with endoscopic therapy or surgery, with better results than in patients with cirrhosis. Nodular regenerative hyperplasia is a histological diagnosis characterized by development of nodules in the liver due to uneven perfusion of the portal venous blood. These patients may develop portal hypertension and if they bleed would require treatment as in NCPF/IPH. Schistosomiasis produces portal hypertension by the development of fibrous tissue around the portal veins as a response to schistosome eggs. Gratifying results have been reported with praziquantel therapy. Rarely sarcoidosis and chronic biliary obstruction may also produce portal venopathy.

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“…reported recently from Sudan [20]. The differences in the prevalence of varices in these studies could partly be due to the difference in the severity of liver fibrosis among studied participants since portal varices have been reported to have a linear relation with fibrosis level [14].…”

Section: Discussionmentioning

confidence: 76%

“…A minimum sample size of 207 patients was estimated from the Lisle-Kish formula for cross-sectional studies, assuming 16.0% of patients with PPF had varices [20] with an allowable error of 0.05 at 95%confidence interval (CI). Eligible patients with PPF were serially recorded in a special gastroenterology registry.…”

Section: Methodsmentioning

confidence: 99%

Schistosoma mansoni -related periportal fibrosis; are APRI and PSDR levels of any potential utility in a well-timed selection of patients for targeted endoscopy in a resource-limited setting?: a case-control clinic-based study

Gunda

Mtui

Manyiri

et al. 2020

Preprint

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Background Schistosoma mansoni related hepatic fibrosis is usually associated with hemodynamic alteration with increased mortality due to bleeding varices. The diagnosis of varices before bleeding imposes a big challenge in resource-limited countries using endoscopy. Published evidence on the utility of non-invasive clinical tools in predicting the presence of varices among patients with S. mansoni related periportal fibrosis is still inadequate including APRI and PSDR levels. This study describes the determinants of portal varices and assesses the potential utility of the APRI and PSDR level in the discrimination of portal varices among patients with S. mansoni related periportal fibrosis. Methods All patients with periportal fibrosis were cross-sectionally assessed for the presence of esophageal varices at Bugando medical centre, in Mwanza Tanzania. Socio-demographic, laboratory and ultrasound data were collected for analysis using STATA 13. The prevalence of varices and associated factors were determined, and the sensitivity and specificity of independent factors were assessed to determine their utility in discriminating presence of varices in patients with PPF. Results In total, 250 patients were included in this study, 109 (43.6%; 95%CI: 37.3-.49.9) of them had varices. On multivariate analysis the odds of having varices were independently increased among patients with higher median APRI levels, (1.51; vs. 0.9; AOR: 5.6; 95%CI: 3.1-10.1; p=<0.001) and PSDR levels that were lower than 5700 (AOR: 3.9; 95%CI: 2.0-7.6; p<0.001. Both APRI and PSDR levels had significantly high sensitivity and specificity in predicting the presence of esophageal varices. Conclusions This study indicates that varices are a common encounter among patients with S. mansoni related periportal fibrosis and it is independently associated with higher median APRI and lower PSDR levels suggesting that these tools are potential discriminators of varices in this subgroup of patients. The reproducibility of these results should further be assessed longitudinally as potential non-invasive tools in selecting patients at high risk of having esophageal varices who could benefit from the targeted endoscopic intervention in a resource-limited setting like ours.

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Prevalence of gastric varices and portal hypertensive gastropathy in patients with Symmers periportal fibrosis

Cited by 5 publications

References 0 publications

Intrapulmonary Vascular Dilatation Evaluated by 99mTc-MAA Scintigraphy and Its Association with Portal Hypertension in Schistosomiasis

Intrapulmonary Vascular Dilatation Evaluated by 99mTc-MAA Scintigraphy and Its Association with Portal Hypertension in Schistosomiasis

Intrahepatic Portal Venopathy and Related Disorders of the Liver

Schistosoma mansoni -related periportal fibrosis; are APRI and PSDR levels of any potential utility in a well-timed selection of patients for targeted endoscopy in a resource-limited setting?: a case-control clinic-based study

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