Clinical and endoscopic aspects of hepatosplenic schistosomiasis in Uganda

Hepatosplenic schistosomiasis is characterized by hepatic periportal fibrosis (Symmers' fibrosis), portal venous obstruction that leads to portal hypertension and its complications, and splenomegaly. Demonstration of pathological lesions due to Schistosoma mansoni can be achieved by using different techniques but because of its sensitivity, specificity and simplicity, ultrasound has replaced wedge biopsy of the liver as the gold standard for detecting schistosomal periportal fibrosis. The aims of the study were to evaluate clinical aspects of schistosomiasis in a well defined area and to assess whether there was a relationship between the grade of periportal fibrosis and the presence of oesophageal varices and their features.

A total of 122 patients with proven schistosome infection were enrolled in the study. Each underwent ultrasound examination to assess hepatosplenic involvement and staging, and upper digestive endoscopy to assess the presence of oesophageal varices and their features. For all the patients, the main characteristics and symptoms, possibly related to schistosomiasis, were also recorded.

A close relationship was found between the grade of periportal fibrosis and the presence of oesophageal varices, their grade and localization in the oesophagus. There was also was a relationship between haematemesis and size of varix, localization of varix and presence of cherry-red spots, but no correlation was found with other endoscopic features of varices.

Clinical aspects of schistosomiasis in Hoima District are similar to what is known from the literature and there are no specific features. The study shows that ultrasonography is an important tool for accurate staging of hepatosplenic schistosomiasis. Although it cannot replace endoscopy, it can direct the need for performing it. In fact, the higher the grade of periportal fibrosis the greater the possibility of having oesophageal varices. Endoscopy is of value in detecting oesophageal varices especially in advanced stages of liver schistosomiasis, in describing their endoscopic features so as to detect those more at risk of bleeding, and for emergency sclerotherapy.