Impact of schistosomal periportal fibrosis on the results of transient elastography (FibroScan) in pure bilharzial patients

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Egypt is considered one of the countries that has a shared burden of chronic liver diseases such as hepatitis C virus (HCV), hepatitis B virus (HBV) and schistosomiasis. Assessment of hepatic fibrosis represents a cornerstone in treatment initiation of chronic HBV patients and treatment prioritization of chronic HCV patients. Transient elastography (TE) is considered one of the important modalities of fibrosis assessment. The impact of schistosomal periportal fibrosis on the reading of the TE device is not well understood.


The aim of this study was to assess the impact of schistosomal periportal fibrosis on readings of TE (FibroScan) in pure bilharzial patients (patients with only bilharziasis as a cause of liver affection).

Patients and methods

A total of 36 bilharzial patients with negative serology for HBV and HCV, negative autoimmune markers, normal serum ferritin and confirmed past or recent schistosomal infection by either stool and urine analysis, egg counting (Kato technique), indirect hemagglutination test or enzyme-linked immunosorbent assay were enrolled in the study and were assessed by abdominal ultrasonography and TE.


In all, three (8.3%) patients had no hepatic periportal fibrosis by abdominal ultrasound, 13 (36.1%) patients had grade I, nine (25%) patients had grade II, and 11 (30%) patients had periportal fibrosis grade III. TE showed a significant difference in the median stiffness among different grades of periportal fibrosis. TE could diagnose significant (≥grade II) and advanced (grade III) hepatic periportal fibrosis.


Patients with hepatic schistosomiasis and significant periportal fibrosis had a higher stiffness on examination with TE, which could influence treatment judgment.

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