Deadly intersection: Schistosomiasis, hepatopulmonary syndrome, and cirrhosis

In this editorial, we comment on the article by Rolim et al in World Journal of Hepatology, which highlights the impacts of hepatopulmonary syndrome (HPS) related to schistosomiasis in patients with and without cirrhosis. Schistosomiasis, a parasitic disease affecting millions worldwide, frequently leads to portal hypertension. Its outcomes are more devastating in cirrhosis than in non-cirrhotic portal hypertension, due to the complex interplay between cirrhosis and HPS, a severe pulmonary vascular complication. Cirrhosis distorts hepatic architecture, impairs portal blood flow, and triggers systemic vascular changes. Schistosomiasis exacerbates portal hypertension and inflammation, further injuring the liver. In non-cirrhotic portal hypertension, significant vascular resistance occurs, but preserved liver function mitigates systemic effects. In contrast, cirrhosis amplifies hypoxia, worsens pulmonary shunting, and predisposes patients to respiratory failure, infection, and death. In a retrospective study of 113 patients, Rolim et al found that cirrhosis had an impact on mortality, yet the presence of HPS did not significantly affect survival. While cirrhosis worsening outcomes are anticipated, HPS should theoretically worsen survival by impairing oxygenation. Early diagnosis, parasite control, and managing cirrhosis-related complications are critical for schistosomiasis-related liver disease. Understanding these differences underscores the importance of integrating liver health into global schistosomiasis management strategies.