title: Changes in portal blood flow and liver functions in cirrhotics during Ramadan fasting in the summer; a pilot study.
abstract: OBJECTIVE
  Assessment of short term changes in portal blood flow and long term changes in liver functions in cirrhotic patients who chose to fast during the month of Ramadan in summer.
  
  
  BACKGROUND
  During Ramadan, healthy Muslims obligated to fast from predawn to sunset.
  
  
  METHODS
  Forty cirrhotic patients intended to fast during the month of Ramadan in the year 2014, were examined by Congestion index (CI) as a non-invasive indicator of short term changes in the portal blood flow, while liver function tests were determined as an indicator of long term changes in liver functions.
  
  
  RESULTS
  A total of 38 patients completed the whole month fasting and two patients discontinued fasting due to variceal bleeding. The complicated patients were 7. CI showed a statistically significant increase from fasting to postprandial status (P<0.001), with statistically significant increases from fasting to postprandial status in Child class A (P<0.001), and B (P<0.001). We did not find a statistical significance between patients with complications and those without complications (P=0.6). There was a statistically significant rise in the serum bilirubin after Ramadan. Deterioration noticed as advanced Child classes, development of lower limb edema, increasing ascites, increasing jaundice and overt encephalopathy.
  
  
  CONCLUSIONS
  Cirrhotic patients showed significant short-term changes in the portal blood flow. However, these changes are not linked to complications or deterioration of liver functions and accommodated especially in patients with Child class A and B. Child class C patients should not fast.
authors.affiliation: Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
authors.forename: Salem Y
authors.initials: SY
authors.lastname: Mohamed
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Emara
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
authors.forename: Hala Im
authors.initials: HI
authors.lastname: Hussien
authors.affiliation: Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt.
authors.forename: Hany M
authors.initials: HM
authors.lastname: Elsadek
keywords: Cirrhosis; Congestion Index; Portal vein; Ramadan Fasting