| Abstract|| |
Background: Schistosoma mansoni infestation may induce liver fibrosis and portal hypertension, with possible elevation of liver enzymes. Aim of the study: The aim of this study was to evaluate the serum gammaglutamyl transpeptidase (GGT) activity in a group of non-alcoholic and non-obese patients with hepatointestinal schistosomiasis. Patients and methods: Medical records of 174 patients diagnosed to have hepatointestinal schistosomiasis on the basis of clinical and laboratory data were reviewed. Body mass index (BMI) was calculated for all patients. Direct stool smear and formol-ether concentration (FEC) methods and hematological and biochemical blood tests were performed. Other studies including abdominal ultrasonography, upper and lower gastrointestinal endoscopy was also performed when feasible. All (174) patients were adults with male to female ratio of 3.8:1. BMI was similar in both groups. Patients were divided into two groups: group 1 (57) with elevated GGT and group 2 (117) patients with normal GGT. Both groups had positive indirect hemagglutination test (IHA) for schistosomiasis. Other causes of liver disease were excluded. Results: Group 1 had significant elevation of alanine aminotransferase (ALT), alkaline phosphatase (ALP) and reduction in platelets (p <0.001), low albumin and high globulin levels (p <0.01) compared to group 2. Abnormal ultrasonographic findings were more frequently encountered in group 1 (p <0.001). Conclusion: The above data indicated that GGT elevation was most likely secondary to hepatobiliary involvement by Schistosoma mansoni and may indicate chronicity. Therefore schistosomiasis has to be considered in our community whenever GGT is elevated in nonalcoholic population
Keywords: GGT, Non-Alcoholics, Schistosomiasis
|How to cite this article:|
Al Mofarreh MA, Al Akwaa AY, Al Mofleh IA. Gammaglutamyl transpeptidase activity in patients with schistosomiasis. Saudi J Gastroenterol 2003;9:15-9
|How to cite this URL:|
Al Mofarreh MA, Al Akwaa AY, Al Mofleh IA. Gammaglutamyl transpeptidase activity in patients with schistosomiasis. Saudi J Gastroenterol [serial online] 2003 [cited 2020 Jan 20];9:15-9. Available from: http://www.saudijgastro.com/text.asp?2003/9/1/15/33362
Schistosomiasis is a widespread disease affecting approximately 200 million individuals all over the world , . In Saudi Arabia, multiple endemic foci of Schistosoma mansoni are scattered over the country , .
Adult worms may survive up to 20 years in the mesentric venous plexus. Eggs are released into the portal circulation and trapped in the liver resulting in a T Cell-mediated granulomatous reaction that results in the disease syndrome  . We repeatedly observed in clinical practice an increase of serum gammaglutamyl transpeptidase (GGT) activity in patients with schistosoma mansoni infestation. While serum GGT elevation is well established in association with alcoholism ,,,, , we found only one study in the world literature that reported elevation of serum GGT in a group of non-alcoholic patients with schistosomiasis  .
The aim of this study was to evaluate the serum GGT activity in a group of non-alcoholic patients with hepatointestinal schistosomiasis in our community.
| Patients and Methods|| |
In a period of six years between 1993-1998, 174 patients coming from various endemic areas in Saudi Arabia were diagnosed to have hepatointestinal schistosomiasis at Dr. Al-Mofarreh's Polyclinic. Medical records of these patients were retrospectively analyzed. All patients were asked about history of diabetes mellitus and hyperlipidemia. The body mass index (BMI) was calculated for all patients. The diagnosis of schistosomiasis was based on clinical and laboratory data including stool examination and indirect hemagglutination (IHA) in all patients. IHA titers of > 1:16 were considered positives. Direct stool smear and formol-ether concentration methods were used to screen for schistosoma mansoni ova. In addition, abdominal ultrasonography (US), upper and lower gastrointestinal endoscopy with rectal biopsies were performed when it was feasible by the same gastroenterologist using pentax EPM-300 vedio scope system. Gammaglutamyl transpeptidase was determined in all patients using biomerieux, France reference values (male 9-37, females 11- 43 unit/L). Patients with recent drug intake, urinary schistosomiasis, or those found to have other reasons for hepatobiliary disorders were not included in the study. Patients were divided into two groups: Group 1 (n = 57) with elevated GGT, and Group 2 (n =117) with normal GGT. Both groups had positive IHA titers. The serum levels of albumin and globulins were tested in 38 and 37 patients in group 1 and group 2 respectively. The laboratory data, abdominal ultrasonography and endoscopy results for both groups were analyzed and 2 x 2 cross-table test was used for statistical analysis. P values <0.05 were considered significant. Liver Biopsy was not performed on outpatients basis in our clinic, and when it was strongly indicated, patients were referred to a hospital.
| Results|| |
All patients were adults with male to female ratio of 3.8:1. The median age was 46. 5 years (range 3080) for group I and 43.2 (20-74) for group 2. BMI ditribution was similar in both groups [Table - 1]. The laboratory data depicted in [Table - 2] shows statistically significant differences between the two groups in regards to ALT, ALP and platelets (p <0.001) as well as globulins and albumin (p <0.01). Only a small proportion of patients had elevated fasting serum glucose (7% and 3%) and cholesterol (7% and 8%) for group 1 and 2 respectivly. Ultrasonographic features summarized in [Table - 3] show more pathological features of fibrosis and cirrhosis in groupl compared to group 2 (p <0.001). Around 50% of patients had fatty liver in either groups. The number of patients with positive ova in stool was 37% in group 1 compared to 45% in group 2 (p = 0.25) as shown in [Table - 4]. On upper gastrointestinal endoscopy, esophageal varices were more frequently encountered in group 1 (10/22) compared to (6/49) patients in group 2 (p<0.001).
| Discussion|| |
Gammaglutamyl transpeptidase is a membrane-bound enzyme which is involved in the metabolic transport , . Among others, it is a useful parameter for intrahepatic cholestasis and disorders of hepatobiliary system ,,,,,,, . It has also been utilized to monitor the status of ethanol consumption ,,,, . In addition raised levels have been reported in primary biliary cirrhosis with regression after treatment , . Furthermore, besides 5-nucleotidase and alkaline phosphatase, GGT has been a sensitive parameter for monitoring intrahepatic cholestasis of pregnancy  .
There is a paucity of information about GGT in individuals with schistosomiasis in the world literature. Martins and Borges suggested that elevation of GGT is correlated with a hepatobiliary alteration induced by schistosomiasis in non alcoholic patient  . All patients included in the current study were Muslims, non alcoholics and their BMI was equally distributed. Cholestasis parameters such as ALP, and GGT were higher in Group 1 (p <0.001), which indicates that this group is likely to have more biliary alteration. In addition, other investigations including ALT, albumin, globulins, platelets, abdominal ultrasonography and upper gastrointestinal endoscopy showed more pathological changes in Group I (p <0.001) suggesting that GGT is a probable indicator for advancement of liver involvement in hepatointestinal schistosomiasis. Although statistically not significant, the decreased proportion of positive ova in the stool in group I might indicate chronicity of the disease in this group with a reduced parasite burden. Since there is no difference between both groups in the BMI and the presence of DM and hypercholestolemia we believe that these factors might have not caused significant difference on GGT serum level in the studied population.
The current data suggest that GGT elevation in the presence of elevated IHA for schistosoma in our non-alcoholic population with hepatointestinal schistosomiasis is most likely related to hepatobiliary involvement and chronicity of the disease. Therefore, schistosorniasis should be considered whenever GGT is elevated in a population of endemic area. Further studies, especially in correlation with morphological findings are warranted.
| Acknowledgment|| |
The authors wish to thank Prof. Dr. Klaus-Peter Maier; Director of Gastroenterology Department, at University of Tuebingen, Esslingen, Germany for reviewing the manuscript and his valuable suggestions. And would like to thank Mr. Amir S. Marzouk, from CMRC, King Saud University, Riyadh, Saudi Arabia for his statistical assistance.
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Mohammad Abdullah Al Mofarreh
Dr. Al Mofarreh Polyclinic, P.O Box 9789, Riyadh 11423
Source of Support: None, Conflict of Interest: None
[Table - 1], [Table - 2], [Table - 3], [Table - 4]