Anicteric cholangiopathy in schistosomiasis patients.
We previously reported that in anicteric patients with the isolated form of schistosomiasis (without co-morbidities) an ursodeoxycholic acid-sensitive increase in serum gamma-glutamyltransferase activity (gammaGT) occurs. We now describe the presence of cholangiopathy in these patients.


METHODS
Sixteen adult anicteric patients with the isolated form of schistosomiasis mansoni were carefully selected: nine with increased gammaGT and seven with normal gammaGT. High sensitive C-reactive protein (CRP), to exclude inflammatory status, hyaluronic acid (HA), and other laboratory parameters were determined. The ultrasonographic study measured spleen length, portal vein and splenic vein diameters, and the portal flow. Magnetic resonance cholangiopancreatography (MRCP) images were interpreted by a blind observer. MRCP was deemed abnormal when focal narrowing and/or paucity of second and third order biliary branches and/or irregularities in the contours of biliary pathways were identified.


RESULTS
Both groups (normal and elevated gammaGT) have preserved hepatic function tests (HA, serum albumin, prothrombin time) and clinical significant portal hypertension (low platelet count and ultrasonographic parameters). MRCP was abnormal in all patients with elevated gammaGT but in only 3 of the 7 patients with normal gammaGT (p=0.003).


CONCLUSIONS
Magnetic resonance cholangiopancreatography characterized a cholangiopatic disorder in anicteric patients with the isolated form of schistosomiasis, even preceding laboratory test alterations.
Brant
Paulo Eugenio
PE
Department of Medicine, Universidade Federal de São Paulo, Rua Jabuticabeiras 807, 05674-011 São Paulo, Brazil.
Kopke-Aguiar
Luciane
L
Shigueoka
David Carlos
DC
Sales
Danilo
D
D'Ippolito
Giuseppe
G
Kouyoumdjian
Maria
M
Borges
Durval R
DR
D000328:Adult; D000818:Animals; D001649:Bile Duct Diseases / Q000469:parasitology*; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D006801:Humans; D006975:Hypertension, Portal; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging; D012555:Schistosomiasis mansoni / Q000150:complications*; D013154:Spleen / Q000000981:diagnostic imaging; D013162:Splenic Vein / Q000000981:diagnostic imaging; D014463:Ultrasonography; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase