الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 128 |  |  |
| | | from | 128 | | |
Abstract
Chronic liver disease (CLD) is an extremely common clinical condition that cause a significant morbidity and mortality and was responsible for 1.3 million deaths worldwide. There had been a 46% increase in CLD mortality in the world between 1980 and 2013 and most of this increase has been reported from low-income countries in Asia and Africa including Egypt. These countries are experiencing demographic and epidemiologic transition in disease burden and Egypt is one of the epicenters of this change. Previously, CLD in Egypt was traditionally attributed to schistosomiasis; with estimated 10% of 200 million persons infected with schistosomiasis were Egyptians in 1980, mainly in the region of Nile Delta. The objectives of the present analysis was to capture the modes of clinical presentation and at which stage CLD patients seek clinical care, as well as the dramatic change in the etiological profile of CLD in this area of Nile Delta.This analysis was based on 1013 newly diagnosed CLD patients over 2 years (2012 to 2014) from a tertiary care center (TLC) across the middle of Nile Delta. Analysis of the demographic data of our study group revealed that CLD predominantly affect males, from rural areas, of relatively younger age ( ” " ~ " ”50 years) during their productive period, a finding that was supported by other studies (1,2). Regarding mode of clinical presentation of the analyzed 1013 CLD patients in this study, our results revealed that a large segment of our CLD patients(” " ~ " ”50%) present at a relatively advanced stage of decompensated cirrhosis (ascites in 22.4% and UGIB in 22.8%), a finding that highlights the importance of screening and building awareness about liver disease in this endemic area of Nile Delta. In this regard, Egypt conducted a successful HCV screening program that covered 50 million residents and treated more than 4 million making Egypt probably the first in the world to eliminate HCV in it’s border. The late presentation of a large segment of our CLD patients was also supported by results of US examination that also revealed that 50%of them presents with late complications of cirrhosis (ascites in 39.2% and HCC in 9.3%). Moreover, our laboratory studies revealed that the synthetic functions of the liver (S. albumin and prothrombin) was also impaired in 62.2% and 38.4% of our CLD patients at presentation. Importantly, CLD patients of schistosomal etiology presented mainly with manifestations of portal hypertension (splenomegaly and UGI Bleed) that was significantly more frequent than the other 2 groups. Also, platelet count was significantly lower in this group of patients that could be attributed to hypersplenism which is another manifestation of portal hypertension. Previously, CLD in Egypt was traditionally attributed to schistosomiasis mainly in the region of Nile Delta until the mid-1980s. Strikingly, our results highlighted the dramatic change in the etiological profile of CLD in this area of Nile Delta. Among the analyzed 1013 CLD patients in our center, the vast majority of them (846=83.5%) have viral etiology, while only 112(11.1%) of them have schistosomal etiology and the remaining 55(5.4%) have non-identified etiology. On further subanalysis, 814(80.3%) out of the 846 CLD patients of viral etiology are HCV-related, 32(3.2%) are HBV-related and the remaining 4(0.4%) are due to mixed infection. Therefore, currently it is evident that HCV had replaced schistosomisis as the predominant cause of CLD in Egypt since the diagnostic serology for HCV become available in 1990s.This was previously attributed solely to parenteral antischistosomal therapy between 1950s and1980s.However, our results revealed that many other risk factors of HCV infection contribute to increased prevalence of HCV among our CLD patients in Nile Delta. 48.1% of them underwent dental procedures, 28.1% underwent surgical procedures, while history of parenteral antischistosomal therapy was obtained only in 13%. Importantly, the underlying etiology of CLD remains unknown in 5.4% of our study group. Since 90% of these CLD patients of unknown etiology (49/55) have also type 2 DM, thus supporting our assumption that they may represent NAFLD/NASH that will be the most important CLD in the near future. Moreover, we may not be able to recognize other uncommon causes of CLD in this group of patients that may also needs other confirmatory tests including histology. Surprisingly, 100 (9.9%) of the analyzed 1013 CLD have HFL at presentation that was proved to be HCC by triphasic liver study in 94 (9.3%).81 (86.2%) of them have viral etiology and the remaining13 (13.8%) were due to non-viral etiology. Therefore, HCV is by far the dominant viral cause of HCC among our CLD in Nile Delta (96.3%), while HBV is still a minor risk factor (3.7%) Finally, based on the result of the present study, it is evident that HCV had replaced schistosomiasis as the predominant cause of CLD in Egypt particularly in the region of Nile Delta. The late presentation of good percentage of our CLD raise the importance of screening programs for CLD in this endemic area of Nile Delta.