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Current Hepatology Reports
Published in: Current Hepatology Reports 3/2023

08-07-2023 | Schistosomiasis

Schistosomiasis: Hepatosplenic Disease and Portal Hypertensive Complications

Authors: David Hudson, Guilherme Grossi Lopes Cançado, Tamoor Afzaal, Gurpreet Malhi, Saranya Theiventhiran, Juan Pablo Arab

Published in: Current Hepatology Reports | Issue 3/2023

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Abstract

Purpose of Review

Schistosomiasis is an important and often neglected disease in tropical climates and is associated with significant comorbidity due to the complication of periportal fibrosis, termed hepatosplenic schistosomiasis. Clinically significant portal hypertension can develop as a complication of periportal fibrosis and is associated with life-threatening gastrointestinal bleeding due to the formation of esophagogastric varices. Unfortunately, patients with established infections can be asymptomatic and may not present for evaluation before significant clinical symptoms are identified.

Recent Findings

Effective screening and prevention programs are paramount to prevent infection and the associated long-term Sequelae. The diagnosis of a chronic infection typically relies on the detection of parasite eggs in the patient’s feces or urine. A combination of clinical examination and imaging is required for the diagnosis of hepatosplenic schistosomiasis. Periportal fibrosis, hepatosplenomegaly or clinically significant portal hypertension are most commonly identified through ultrasound-based imaging. The management of hepatosplenic disease relies on the application of parasite-directed pharmaceuticals, with endoscopic, surgical, or interventional radiology techniques directed toward portal hypertensive complications. Endoscopic band ligation is currently one of the most popular methods used to manage esophageal varices in patients with hepatosplenic complications.

Summary

Given the lack of head-to-head treatment trials, a combination of esophagogastric devascularization with subtotal splenectomy, postoperative band ligation or sclerotherapy, and beta-blockers may be the best approach for patients with refractory symptoms. Further studies are needed to identify the potential role of the transjugular intrahepatic portosystemic shunt procedure in hepatosplenic schistosomiasis. Liver transplantation is rarely performed in patients with hepatosplenic schistosomiasis. Given the significant comorbidities of long-term infections, the most effective strategy is a combination of early screening and eradication programs, along with preventative programs targeting the socioeconomic determinants of schistosomiasis infections.
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Metadata
Title
Schistosomiasis: Hepatosplenic Disease and Portal Hypertensive Complications
Authors
David Hudson
Guilherme Grossi Lopes Cançado
Tamoor Afzaal
Gurpreet Malhi
Saranya Theiventhiran
Juan Pablo Arab
Publication date
08-07-2023
Publisher
Springer US
Published in
Current Hepatology Reports / Issue 3/2023
Electronic ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-023-00612-9

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