title: Oesophageal varices, schistosomiasis, and mortality among patients admitted with haematemesis in Mwanza, Tanzania: a prospective cohort study.
abstract: BACKGROUND
  Upper gastrointestinal bleeding (UGIB) is a common cause of hospital admissions worldwide. Aetiologies vary by sociodemographics and geography. Retrospective studies of endoscopies in much of Africa have documented oesophageal varices as a leading cause of UGIB. Prospective studies describing outcomes and associations with clinical factors are lacking.
  
  
  METHODS
  We conducted a prospective cohort study at a referral hospital in Mwanza, Tanzania where schistosomiasis is endemic. Adults admitted with haematemesis underwent laboratory workup, schistosomiasis antigen testing and elective endoscopy, and were followed for two months for death or re-bleeding. We assessed predictors of endoscopic findings using logistic regression models, and determined prediction rules that maximised sensitivity and positive predictive value (PPV).
  
  
  RESULTS
  Of 124 enrolled patients, 13 died within two months (10%); active schistosomiasis prevalence was 48%. 64/91(70%) patients had oesophageal varices. We found strong associations between varices and numerous demographic or clinical findings, permitting construction of simple, high-fidelity prediction rules for oesophageal varices applicable even in rural settings. Portal vein diameter ≥ 13 mm or water sourced from the lake yielded sensitivity, specificity, PPV and NPV >90% for oesophageal varices; presence of splenomegaly or water sourced from the lake maintained sensitivity and PPV >90%.
  
  
  CONCLUSIONS
  Our results guide identification of patients, via ultrasound and clinical examination, likely to have varices for whom referral for endoscopy may be life-saving. Furthermore, they support empiric anti-schistosome treatment for patients with UGIB in schistosome-endemic regions. These interventions have potential to reduce UGIB-related morbidity and mortality in Africa.
authors.affiliation: Department of Internal Medicine, Bugando Medical Centre, Box 1370, Mwanza, Tanzania. awilchofle12@gmail.com.
authors.forename: Awilly A
authors.initials: AA
authors.lastname: Chofle
authors.forename: Hyasinta
authors.initials: H
authors.lastname: Jaka
authors.forename: Mheta
authors.initials: M
authors.lastname: Koy
authors.forename: Luke R
authors.initials: LR
authors.lastname: Smart
authors.forename: Rodrick
authors.initials: R
authors.lastname: Kabangila
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Ewings
authors.forename: Humphrey D
authors.initials: HD
authors.lastname: Mazigo
authors.forename: Warren D
authors.initials: WD
authors.lastname: Johnson
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.forename: Robert N
authors.initials: RN
authors.lastname: Peck
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Downs
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012552:Schistosomiasis / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D013636:Tanzania / Q000453:epidemiology