# Liver and spleen ultrasonography and elastography are useful for identifying a history of upper gastrointestinal bleeding in patients with schistosomiasis

## TL;DR

Ultrasonography and elastography of the liver and spleen can help identify patients with schistosomiasis who have a history of upper gastrointestinal bleeding.

## Contribution

The study introduces the use of ultrasonographic and elastographic parameters, particularly the splenic index, to identify UGIB in schistosomiasis patients.

## Key findings

- Patients with a history of UGIB showed more advanced PPF, larger portal and splenic vein diameters, and increased spleen size and stiffness.
- The splenic index (cut-off >65.2) had the highest accuracy (AUC=0.804) in identifying UGIB history.
- A splenic index <65.2 strongly predicts the absence of UGIB (negative likelihood ratio of 0.064).

## Abstract

Schistosoma mansoni infection can lead to periportal fibrosis (PPF), non-cirrhotic (pre-sinusoidal) portal hypertension, development of varices, and gastrointestinal bleeding. In this context, we evaluated hepatic disease morbidity and signs of portal hypertension in patients with schistosomiasis, with and without a history of upper gastrointestinal bleeding (UGIB), using ultrasonography and point shear wave elastography (pSWE) of the liver and spleen.

An analytical case-control study involving 177 patients with schistosomiasis, with and without a UGIB history, conducted at the Gastroenterology Division of the Hospital das Clínicas-UFPE, between 2018 and 2024. All patients underwent upper abdominal ultrasonography and hepatic and splenic stiffness on pSWE.

Among the 177 patients with schistosomiasis, 91 (51.4%) were women; with a median age of 55 years; 51 patients (28.8%) reported a history of UGIB. These 51 patients presented more advanced PPF patterns, larger portal and splenic vein diameters, increased longitudinal and transverse spleen diameters (splenic index), and greater liver and spleen stiffness on pSWE. Most of them (84.3%) had advanced PPF (patterns E or F), which are associated with marked splenic enlargement and an increased risk of portal hypertension. The ROC curve analysis identified the following cut-off values for distinguishing patients with a history of UGIB: portal vein diameter > 1.3 cm, splenic vein diameter > 0.79 cm, splenic index > 65.2, liver and spleen pSWE velocity > 1.5 m/s and > 3.56 m/s, respectively. Among these parameters, the splenic index demonstrated the highest high accuracy (AUC = 0.804) in identifying patients with a history of UGIB and a robust performance in ruling out this condition with a negative likelihood ratio (LR-) of 0.064. This finding implies that a splenic index < 65.2 is a strong predictor of the absence of UGIB.

Ultrasonographic and elastographic parameters, particularly those related to the spleen, with emphasis on the splenic index, proved to be promising tools for identifying patients with schistosomiasis with a history of UGIB.

The study was approved by the Research Ethics Committee of the Health Sciences Center at Universidade Federal de Pernambuco (UFPE) (Approval No. 7.112.760/2024), and all participants provided written informed consent. The study was conducted in full accordance with the ethical principles outlined in the Declaration of Helsinki of the World Medical Association.

The online version contains supplementary material available at 10.1186/s12879-025-11635-6.