Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding.
BACKGROUND
Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Mansons schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni.


OBJECTIVE
To evaluate duplex sonography findings in patients with hepatosplenic Mansons schistosomiasis with and without upper gastrointestinal variceal hemorrhage.


METHODS
A cross-sectional study was performed whereby 27 consecutive patients with hepatosplenic Mansons schistosomiasis were divided into two groups: group I (six men and six women; mean age 48.7 years) with a past history of bleeding and group II (four men and eight women; mean age 44.7 years) without a past history of upper gastrointestinal bleeding, underwent duplex sonography examination. All patients underwent the same upper gastrointestinal endoscopy and laboratory examinations. Those with signs of mixed chronic liver disease or portal vein thrombosis (three cases) were excluded.


RESULTS
Group I showed significantly higher mean portal vein flow velocity than group II (26.36 cm/s vs 17.15 cm/sec). Although, as a whole it was not significant in all forms of collateral vessels (83% vs 100%), there was a significantly higher frequency of splenorenal collateral circulation type in group II compared with group I (17% vs 67%). The congestion index of the portal vein was significantly lower in group I than in group II (0.057 cm vs 0.073 cm/sec).


CONCLUSIONS
Our duplex sonography findings in hepatosplenic Mansons schistosomiasis support the idea that schistosomotic portal hypertension is strongly influenced by overflow status, and that collateral circulation seems to play an important role in hemodynamic behavior.
Arruda
Severino Marcos Borba de
SM
Department of Internal Medicine, Gastroenterology and Endoscopy Division, Federal University of Pernambuco, Brazil. smbarruda@uol.com.br
Barreto
Victorino Spinelli Toscano
VS
Amaral
Fernando José do
FJ
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000469:parasitology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000469:parasitology; D005773:Gastroscopy; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging / Q000469:parasitology; D008109:Liver Diseases, Parasitic / Q000000981:diagnostic imaging / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012555:Schistosomiasis mansoni / Q000150:complications / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D013158:Splenic Diseases / Q000000981:diagnostic imaging / Q000469:parasitology; D018616:Ultrasonography, Doppler, Duplex