Department of Infectious-Tropical Diseases and Microbiology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
Department of Gastroenterology, Hepatology and Infectious Diseases, Duesseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany.
PLoS Negl Trop Dis. 2021 Mar 25;15(3):e0009191. doi: 10.1371/journal.pntd.0009191. eCollection 2021 Mar.
Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS.
METHODOLOGY/PRINCIPAL FINDINGS: We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking.
Most interventions have been developed on the basis of individual groups' experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.
肝脾血吸虫病（HSS）是由曼氏血吸虫属寄生虫在肠系膜丛中慢性感染引起的疾病；门静脉高压导致胃肠道出血是该疾病最危险的并发症。HSS 需要复杂的临床管理，但目前尚无具体的指南。我们旨在提供有关 HSS 诊断和治疗的综合研究结果和知识空白的全面描述。
方法/主要发现：我们通过 MEDLINE 和 EMBASE 数据库回顾了过去 40 年中发表的无合并感染的 HSS 患者的相关原始出版物。未研究吡喹酮治疗和 HSS 相关肺动脉高压。在纳入的 60 篇出版物中，13 篇重点关注诊断方面，45 篇关注治疗方面，2 篇同时关注两个方面。使用效果方向图总结结果。最常见的诊断方法是根据静脉曲张出血风险对患者进行分层，包括使用超声和血小板计数；相反，缺乏评估和使用非侵入性工具来指导治疗干预选择。治疗方面的出版物包括使用β受体阻滞剂、食管静脉曲张的局部治疗、手术和经颈静脉肝内门体分流术。总体而言，治疗方法和测量结果存在异质性，缺乏关于胃肠道出血一级预防干预和干预后长期随访的数据。
大多数干预措施都是基于个别团体的经验制定的，几乎从未进行过严格比较；此外，缺乏数据表明哪些参数可以指导干预措施的选择。这些结果突出表明，迫切需要在不同环境中实施具有长期随访的严格前瞻性研究，以填补全球仍有数百万患者受到影响的这种疾病存在的这些基本空白。
