Natural History of Hepatosplenic Schistosomiasis (HSS) Non–Cirrhotic Portal Hypertension (NCPH): Influence of Gastrointestinal Bleeding and Decompensation in Prognosis

Survival of patients with hepatopulmonary syndrome related to cirrhotic and non-cirrhotic (schistosomiasis) portal hypertension

BACKGROUND

The hepatosplenic schistosomiasis (HSS) with portal hypertension can cause vascular complications such as hepatopulmonary syndrome (HPS). HPS increases the risk of mortality in patients with cirrhosis; however, there is no data on the mortality of patients with HSS and HPS.

AIM

To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic (schistosomiasis) portal hypertension.

METHODS

From August 2023 to January 2024, medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed. Survival curves were created using the Kaplan-Meier method, and comparisons were performed using the log-rank test. Cox regression models estimated the hazard ratios (HR).

RESULTS

Overall, data of 113 patients were analyzed; most (55.8%) had HSS and concomitant cirrhosis (HSS/cirrhosis). Meanwhile, HPS was present in 39 (34.5%) patients. Death occurred in 65 patients [57.5%; 95% confidence interval (CI): 48%-67%. The average time to death was lower in those with HPS when compared to those without HPS (3.37 years vs 5.65 years; P = 0.017). According to the cause of liver disease, patients with HSS/cirrhosis died earlier, and their risk of death was twice as high compared with patients with HSS without cirrhosis (HR: 2.17; 95%CI: 1.3-3.60; P = 0.003). Meanwhile, there were no differences when comparing the two groups with and without HPS (HR: 1.01; 95%CI: 0.59-1.73; P = 0.967).

CONCLUSION

Patients with HSS and concomitant cirrhosis had a lower survival rate, but there was no difference in survival regardless of the presence of HPS.

Transjugular intrahepatic portosystemic shunt followed by splenectomy for complicated hepatosplenic schistosomiasis: a case report and review of the literature

Hepatosplenic schistosomiasis is a complex clinical condition caused by the complications of chronic infection with Schistosoma species that cause intestinal schistosomiasis. Hepatosplenic schistosomiasis derives from the fibrotic reaction stimulated around parasite eggs that are transported by the mesenteric circulation to the liver, causing periportal fibrosis. Portal hypertension and variceal gastrointestinal bleeding are major complications of hepatosplenic schistosomiasis. The clinical management of hepatosplenic schistosomiasis is not standardised and a parameter that could guide clinical decision making has not yet been identified. Transjugular intrahepatic portosystemic shunt (TIPS) appears promising for use in hepatosplenic schistosomiasis but is still reported in very few patients. In this Grand Round, we report one patient with hepatosplenic schistosomiasis treated with TIPS, which resulted in regression of oesophageal varices but had to be followed by splenectomy due to persisting severe splenomegaly and thrombocytopenia. We summarise the main challenges in the clinical management of this patient with hepatosplenic schistosomiasis, highlight results of a scoping review of the literature, and evaluate the use of of TIPS in patients with early hepatosplenic schistosomiasis, to improve the prognosis.