Minireviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2022; 14(4): 696-707
Published online Apr 27, 2022. doi: 10.4254/wjh.v14.i4.696
Noninvasive diagnosis of periportal fibrosis in schistosomiasis mansoni: A comprehensive review
Joelma Carvalho Santos, Caroline Louise Diniz Pereira, Ana Lúcia Coutinho Domingues, Edmundo Pessoa Lopes
Joelma Carvalho Santos, Caroline Louise Diniz Pereira, Ana Lúcia Coutinho Domingues, Edmundo Pessoa Lopes, Postgraduate Program in Tropical Medicine, Center of Health Sciences, Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil
Ana Lúcia Coutinho Domingues, Edmundo Pessoa Lopes, Gastroenterology Division, Department of Internal Medicine of Center of Health Sciences, Hospital das Clínicas - Universidade Federal de Pernambuco, Recife 50670-901, Pernambuco, Brazil
Author contributions: Santos JC and Pereira CLD wrote the paper; Domingues ALC and Lopes EP contributed to the concept and the revision of the paper.
Conflict-of-interest statement: All authors declare that there is no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Edmundo Pessoa Lopes, MD, PhD, Professor, Staff Physician, Postgraduate Program in Tropical Medicine, Center of Health Sciences, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 135, Recife 50670-901, Pernambuco, Brazil. epalopes@uol.com.br
Received: June 21, 2021
Peer-review started: June 21, 2021
First decision: September 2, 2021
Revised: September 14, 2021
Accepted: March 14, 2022
Article in press: March 14, 2022
Published online: April 27, 2022
Processing time: 304 Days and 14 Hours
Abstract

Schistosomiasis mansoni is a neglected disease and key public health problem, mainly due to its high prevalence, the scarcity of public policies, and the severity of some clinical forms. Periportal fibrosis (PPF) is the commonest complication of chronic schistosomiasis mansoni and its diagnosis requires different techniques. Even though wedge biopsy of the liver is considered the gold standard, it is not justified in non-surgical patients, and percutaneous liver biopsy may be informative but does not have sufficient sensitivity. Noninvasive PPF tests mostly include biological (serum biomarkers or combined scores) or physical assessments (imaging assessment of fibrosis pattern or tissue stiffness). Moreover, imaging techniques, such as ultrasound, computed tomography, magnetic resonance imaging, and elastography are applied not only to support the diagnosis of schistosomiasis, but also to assess and detect signs of portal hypertension and organ damage due to chronic schistosomiasis. A combination between a comprehensive history and physical examination with biomarkers for liver fibrosis and imaging methods seems to offer the best approach for evaluating these patients. In addition, understanding their strengths and limitations will allow a more accurate interpretation in the clinical context and can lead to greater accuracy in estimating the degree of fibrosis in patients with Schistosomiasis mansoni (S. mansoni) infection. This review will discuss the different noninvasive methods that are currently available for the evaluation of PPF in S. mansoni infection, and their application, advantages, and limitations in clinical practice.

Keywords: Schistosoma mansoni; Parasitic liver diseases; Liver fibrosis; Biomarkers; Elasticity imaging techniques; Ultrasonography

Core Tip: Schistosomiasis mansoni is a neglected and key public health problem and periportal fibrosis (PPF) is its commonest complication. Noninvasive PPF tests mostly include biological or physical assessments. Imaging techniques have been currently applied to assess and detect liver damage due to chronic schistosomiasis. A combination between these biomarkers, a comprehensive history and physical examination, laboratory tests, and imaging methods seems to offer the best approach for evaluating these patients. We herein discuss the different noninvasive methods that are currently available for evaluating PPF in Schistosomiasis mansoni infection, and their application, advantages, and limitations in clinical practice.