The natural history of bleeding oesophageal varices in patients with schistosomal portal hypertension

Shakir Z Ibrahim, Beshir M Arbab, Suleiman H Suleiman, Osman Abdelwahab, Shawgi H Elmasri, Mohammed A Hassan

Abstract


Aim: to study the natural history of bleeding oesophageal varices in schistosomal portal hypertension.
Methods: 100 patients who bled from schistosomal oesophageal varices were studied. They were the control group in a prospective randomized clinical trial testing the efficacy of surgery in preventing further variceal
bleeding. They had clinical, laboratory, sonographic and endoscopic evaluation in a special portal hypertension clinic. They were followed up for a mean period of 19.9 months. End points for follow up were recurrence of
variceal bleeding, and or death.
Results: there were 84 males and 16 females with a mean age of 36.3 ± 6.7. The mean period between diagnosis of schistosomiasis and onset of bleeding was 6.4±1.6 years (range 3-13 years). 53% had two or more previous
bleeds. The mean period between the first and last bleed before presentation was 3.1±0.3 years (range 1 month to 6 years). A mean of 3.7±0.23 units of blood per bleed were required for resuscitation during previous
episodes of bleeding. At presentation, 30% had mild to moderate ascitis responsive to medical treatment. They had varying degrees of hypersplenism, and good hepatic function. 67.6% had grade III and IV varices. 89
patients were available for follow up. 57 (64%) re-bled from their varices, 38 of them (42.7%) within one year.
Significant risk factors for re-bleeding were; large volumes of blood transfusion for resuscitation (p<0.001), and large spleens (p<0.05). 18 patients (20.2%) died from recurrent variceal bleeding. 15 of them died in rural
hospitals and 3 in central hospitals.
Conclusion: Despite surviving repeated episodes of variceal haemorrhage, a significant number of patients with schistosomal varices are at risk of re-bleeding and death. They should be offered early definitive treatment.
*Corresponding author: Department of surgery, Faculty of Medicine, University of Khartoum. PO Box 102 Khartoum, Sudan, szeialimam@yahoo.co.uk

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ISSN: 1858-5345