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Schistosomiasis: Hepatosplenic Disease and Portal Hypertensive Complications

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Abstract

Purpose of Review

Schistosomiasis is an important and often neglected disease in tropical climates and is associated with significant comorbidity due to the complication of periportal fibrosis, termed hepatosplenic schistosomiasis. Clinically significant portal hypertension can develop as a complication of periportal fibrosis and is associated with life-threatening gastrointestinal bleeding due to the formation of esophagogastric varices. Unfortunately, patients with established infections can be asymptomatic and may not present for evaluation before significant clinical symptoms are identified.

Recent Findings

Effective screening and prevention programs are paramount to prevent infection and the associated long-term Sequelae. The diagnosis of a chronic infection typically relies on the detection of parasite eggs in the patient’s feces or urine. A combination of clinical examination and imaging is required for the diagnosis of hepatosplenic schistosomiasis. Periportal fibrosis, hepatosplenomegaly or clinically significant portal hypertension are most commonly identified through ultrasound-based imaging. The management of hepatosplenic disease relies on the application of parasite-directed pharmaceuticals, with endoscopic, surgical, or interventional radiology techniques directed toward portal hypertensive complications. Endoscopic band ligation is currently one of the most popular methods used to manage esophageal varices in patients with hepatosplenic complications.

Summary

Given the lack of head-to-head treatment trials, a combination of esophagogastric devascularization with subtotal splenectomy, postoperative band ligation or sclerotherapy, and beta-blockers may be the best approach for patients with refractory symptoms. Further studies are needed to identify the potential role of the transjugular intrahepatic portosystemic shunt procedure in hepatosplenic schistosomiasis. Liver transplantation is rarely performed in patients with hepatosplenic schistosomiasis. Given the significant comorbidities of long-term infections, the most effective strategy is a combination of early screening and eradication programs, along with preventative programs targeting the socioeconomic determinants of schistosomiasis infections.

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Funding

Juan Pablo Arab receive support from the Chilean government through the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT 1200227). Figures were partially made with Biorender.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Schulich School of Medicine, Western University & London Health Sciences Centre, London, ON, Canada

    David Hudson, Tamoor Afzaal, Gurpreet Malhi & Juan Pablo Arab

  2. Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Guilherme Grossi Lopes Cançado

  3. Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, Brazil

    Guilherme Grossi Lopes Cançado

  4. Department of Neuroscience, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

    Saranya Theiventhiran

  5. Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, ON, Canada

    Juan Pablo Arab

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Contributions

Authors confirm contribution to the article as follows: DH: investigation, writing — original draft, writing — review and editing. GGLC: investigation, writing — original draft, writing — review and editing. TA: investigation, writing — original draft, writing — review and editing. GM: investigation, writing — original draft, writing — review and editing. ST: investigation, writing — original draft, writing — review and editing. JPA: conceptualization, writing — review, editing and supervision.

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Correspondence to Juan Pablo Arab.

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Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/international guidelines).

AST, asparate aminotransferase; ULN, upper limit of normal; ALP, alkaline phosphatase.

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Hudson, D., Cançado, G.G.L., Afzaal, T. et al. Schistosomiasis: Hepatosplenic Disease and Portal Hypertensive Complications. Curr Hepatology Rep 22, 170–181 (2023). https://doi.org/10.1007/s11901-023-00612-9

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