SONOGRAPHIC PREDICTION OF VARICEAL BLEEDING IN PATIENTS WITH LIVER FIBROSIS DUE TO SCHISTOSOMA-MANSONI

Several studies have shown that the characteristic hepatic abnormaliti es:induced by Schistosoma mansoni detectable by ultrasound correlate w ith the degree of oesophageal varices. So far the value of ultrasound for predicting variceal haemorrhage has not been assessed. Fifty Brazi lian patients with schistosomal periportal fibrosis from Alagoas State , 18 of whom had already bled from oesophageal varices, were enrolled in a combined cross-sectional and longitudinal study and investigated clinically, by endoscopy and by ultrasound. Twenty-seven of the patien ts were monitored until another bleeding episode, death or for a minim um of 28 months. Eight of these patients could be followed up for a fu rther three years. A sonographic score, which accounts for the degree of echogenic periportal thickening and of portal vein dilatation, was calculated for all patients. A highly significant correlation (P < 0.0 001) existed between the sonographic score and the occurrence of previ ous variceal haemorrhage, paralleled by a similar correlation between the sonographic score and the degree of oesophageal varices (P < 0.001 ). In the 27 patients monitored longitudinally, the sonographic scan i ndicated the risk of future variceal bleeding (P < 0.0001). The sonogr aphic score reliably predicts the risk of variceal bleeding in individ ual patients with periportal fibrosis. Hence, the application of endos copy, if available at all in endemic areas, may be restricted to the p atients at risk of future variceal bleeding, as determined by ultrasou nd. Since portable devices can be carried even to remote areas, the ap plication of the proposed score in community surveys could provide a n ew means for the identification of high-risk patients in S. mansoni-in fected populations.