CLINICAL AND ENDOSCOPIC ASPECTS OF HEPATOSPLENIC SCHISTOSOMIASIS IN UGANDA

Introduction: Hepatosplenic schistosomiasis is characterized by hepati c periportal fibrosis (Symmers' fibrosis), portal venous obstruction t hat leads to portal hypertension and its complications, and splenomega ly. Demonstration of pathological lesions due to Schistosoma mansoni c an be achieved by using different techniques but because of its sensit ivity, specificity and simplicity, ultrasound has replaced wedge biops y of the liver as the gold standard for detecting schistosomal peripor tal fibrosis. The aims of the study were to evaluate clinical aspects of schistosomiasis in a well defined area and to assess whether there was a relationship between the grade of periportal fibrosis and the pr esence of oesophageal varices and their features. Materials and method s: A total of 122 patients with proven schistosome infection were enro lled in the study. Each underwent ultrasound examination to assess hep atosplenic involvement and staging, and upper digestive endoscopy to a ssess the presence of oesophageal varices and their features. For all the patients, the main characteristics and symptoms, possibly related to schistosomiasis, were also recorded. Results: A close relationship was found between the grade of periportal fibrosis and the presence of oesophageal varices, their grade and localization in the oesophagus. There was also was a relationship between haematemesis and size of var ix, localization of varix and presence of cherry-red spots, but no cor relation was found with other endoscopic features of varices. Conclusi on: Clinical aspects of schistosomiasis in Hoima District are similar to what is known from the literature and there are no specific feature s. The study shows that ultrasonography is an important tool for accur ate staging of hepatosplenic schistosomiasis. Although it cannot repla ce endoscopy, it can direct the need for performing it. In fact, the h igher the grade of periportal fibrosis the greater the possibility of having oesophageal varices. Endoscopy is of value in detecting oesopha geal varices especially in advanced stages of liver schistosomiasis, i n describing their endoscopic features so as to detect those more at r isk of bleeding, and for emergency sclerotherapy.