Introduction Worldwide the commonest cause of portal hypertension is cirrhosis, but in tropics schistosomiasis is a major cause. Parts of Zambia are hyper-endemic, with up to 77% prevalence in some areas. Due to preservation of hepatocellular function, prognosis of gastrointestinal bleed due to hepato-splenic schistosomiasis is considered better than in cirrhosis. To confirm liver fibrosis the gold standard is a liver biopsy but this is invasive and and prone to sampling error. We set out to observe the fibrotic markers and also evaluate inflammatory makers in patients with hepato- splenic schistosomiasis at the University Teaching Hospital (UTH) in Zambia.
Methods This is a case control study of schistosomal related portal hypertension at the University Teaching Hospital in Lusaka Zambia. 40 patients have been recruited since mid September 2012 and the study is ongoing. All patients had varices. Blood was drawn to cheque full blood count, viral hepatitis profile, renal and liver function tests. Laminin and hyaluronic acid were used as markers of liver fibrosis while TNF receptor 1 and sCD14 were used as markers of inflammation. Serology for Schistosoma antibodies was done. Stool for parasitology and abdominal ultrasound were done. All patients were on propranolol or nadolol aiming for the pulse of less than 60/minute.
Results 40 patients were evaluated. The sex ratio was M:F 23:17 and the mean age was 40.5. Serology for schistosomiasis was positive in 34 (85%) and negative in 6 (15%) patients. All patients were sero-negative for HIV except one and were sero-negative for hepatitis B and C viruses. All patients had marked thrombocytopenia with the median being 49 × 109/L (IQR 33.5–69.5) × 109/L. Median ALT was 29.35 U/l ( IQR 22.1–41.2) with 77.5% in the normal range. Of the 28 patients who submitted stool for parasitology 17 (61%) had no organism isolated, 4 (14%) had hook worms, 3 (11%) had Schistosoma eggs, 2 (7%) had ascaris and 2 (7%) had other organisms. Laminin levels (median 1608 ng/l, IQR 1416–1898) were all above normal. Hyaluronic acid levels were all higher than any of the standards in the ELISA kits and will have to be diluted to obtain precise values. All patients had elevated inflammatory markers: TNF receptor 1 concentrations were 10965 pg/ml (IQR 7990–15660; upper limit of normal 1966 pg/ml). Soluble CD14 values measured in ng/ml were equally found to be higher, median being 2469 (IQR1792–3119); upper limit of normal 2200ng/ml.
Conclusion Schistosomiasis is a leading cause of portal hypertension in Zambia and it is associated with high levels of liver fibrotic markers which could be used to assess disease severity. It appears like hepato-splenic schistosomiasis induces high levels of inflammatory markers such as TNF receptor 1 and s CD14.
Disclosure of Interest None Declared.
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