The frequency of liver fibrosis and clinical symptoms in patients with opisthorchiasis

Background. The importance of the problem of opisthorchiasis is dictated by the long-lasting disease duration with possible complications provoking the formation of periportal fibrosis, recurrent pancreatitis, cholecystitis, gallstone disease, and cholangiocarcinoma. Objective. The evaluation of clinical and biochemical manifestations in patients with chronic opisthorchiasis, depending on the severity of liver fibrosis (LF). Methods. 58 patients with chronic opisthorchiasis (33 men and 25 women; mean age - 42.3 years) and 25 healthy patients (14 men and 11 women; mean age - 41.5 years) aged 24 to 60 years were examined. Opisthorchiasis was diagnosed in all 58 patients by determining the eggs or bodies of adult parasites in duodenal contents and/or feces (according to the Kato technique). Clinical symptoms and medical history were studied using a standard questionnaire developed on the basis of current international classifications. To diagnose concomitant changes and complications, all patients underwent ultrasound examination of the liver and pancreas, and fibrogastroscopy. LF was studied in all 58 patients with opisthorchiasis by the elastometry using Aixplorer (France) or Siemens Acuson S2000 (Germany) ultrasound systems according to the METAVIR scale with 4 degrees of fibrosis. The control group was recruited from healthy individuals who did not present gastroenterological problems during the annual medical examination, did not have pronounced chronic diseases of various organs and systems, were characterized by normal clinical and biochemical blood tests, lack of viral hepatitis markers and antibodies to opisthorchis, and had no history of alcohol abuse. Results. The most common clinical manifestations of opisthorchiasis included astheno-vegetative syndrome (60.3%), right subcostal pain (34.5%) and pain in the lower abdomen associated with altered defecation pattern (17.2%). The systemic nature of the clinical manifestations of the studied parasitosis was indicated by a high frequency of articular syndrome (24.1%) and skin itching (25.9%). METAVIR F2 stage LF was registered in 20.7% of the examined individuals, and F3-F4 stage LF was detected in 17.2% of patients with opisthorchiasis. In opisthorchiasis patients, weekly right subcostal pain, bloating, skin itching, articular and asthenovegetative syndromes, hepatomegaly, and an increase in blood transaminase, alkaline phosphatase and total bilirubin levels were associated with severe LF. Conclusion. In patients with opisthorchiasis, clinical symptoms were clearly associated with the severity of LF. A significant proportion of patients with opisthorchiasis had biochemical equivalents of cytolytic and cholestatic syndromes, which indicates the presence of an aggressive inflammatory process in the liver. We found a high incidence of severe LF (METAVIR F2-F4 stage), which verifies the basic concept of our study. The project “Immuno-biochemical model for predicting the severity of precancerous changes in the liver in patients with chronic opisthorchiasis" was carried out with the support of the Krasnoyarsk Regional Fund for the Support of Scientific and Technical Activities (application code: 2019051404996).

Opisthorchis felineus, opisthorchiasis, hepatic fibrosis, Opisthorchis felineus, carcinogenesis