The mean age in our study was 52 years, which is comparable to the ages of 45 and 55 years reported in Sudan and Nepal [5, 6]. Males predominated at 71%, similar to a study conducted in Saudi Arabia, which reported a male percentage of 74% [7]. Male sex was also statistically associated with esophageal varices (p < 0.05). The variation between male and female ratios was also observed in similar studies in Sudan [8, 9]. Gender-based differences in occupational and environmental exposures might contribute to this heterogeneity.
47% of the population were from Khartoum State, followed by Aljazeera (30%), which is known for its agricultural scheme, a major risk factor that makes it an endemic area with schistosomiasis. In 2021, a study reported that this endemic species migrated north towards Khartoum State as well [10].
A high esophageal varices burden in Sudan has been reported in literature [8], consisting with our findings, which reported a percentage of 60.6% as the most common endoscopic finding among patients, although a reduction in comparison to previous records was noted [9], with a history of schistosomiasis being present in 35.3% of the study population.
A figure that is lower than what was reported in previous local and regional reports. In rural sub-Saharan Africa, chronic hepatic schistosomiasis accounts for 94% of upper GI bleeders [11]. In Tanzania, active schistosomal infection accounts for approximately 48% of patients who present with haematemesis [12]. A study conducted in Wad Madani, Sudan, reported that 93% of patients presenting with upper GI variceal bleeding consequent to portal hypertension had a past medical history of schistosomiasis [13]. Whether this observation reflects improved public health policies, such as mass praziquantel campaigns and improved sanitation, or a selection bias, should be investigated.
The majority of those patients had previously experienced at least one similar bleeding episode, and despite the sparsity of data on long-term recurrence rates, a 3-year recurrence rate was observed. Rebleeding as 2 episodes or more was observed in 57% of the patients in one study [11], which is similar to the findings in our study (55%).
Gastric varices constituted 21% of all cases, which, in most cases, were accompanied by esophageal varices. Isolated gastric varices were found in 27 (5%) patients. These results suggest an increase in the number of gastric varices, which might be due to increased sensitivity and improved reporting of their presence. Gastritis came after, aligning with the previously published literature on the change of gastrointestinal endoscopy of the Sudanese population towards gastritis in Sudan [10]. A comparison between endoscopic profiles from different regions is described in Table 5 below.
A total of 13.3% of NSAID-takers in high-risk groups might reflect a lack of adjustment of risk factors [14]. In contrast, the number of patients who were taking beta blockers implies a pattern of noncompliance, as they were taken by 103 (20.1) individuals who presented with upper gastrointestinal bleeding. Adherence to beta-blockers and medication in low-resource areas can be attributed to the inability to meet costs, inaccessibility, and lack of proper awareness. The antihypertensive and hypoglycemic drug rates were 5.8% and 5.3%, respectively, reflecting the associated comorbidities.
Findings suggest that our population is at high risk, as evidenced by the frequent presentation with moderate to severe anaemia, which is underestimated by possible selection bias after exclusion of patients with incomplete endoscopic findings because these particular groups might have presented very critically and died from severe bleeding before being stabilised for the procedure.
The fact that 20% of the study population presented with gastric varices further highlights the urgency of their presentation, as gastric varices can lead to more severe and massive gastric bleeding [15]. Both gastric and esophageal varices were found to be significantly associated with higher.ecurrence rates in our findings. The literature suggests a 93.5% recurrence rate for esophageal varices within 3 years [16]. All these factors highlight the importance of routine endoscopic screening and expanded access to secondary prophylaxis in high-risk populations.
Differences in haemoglobin values between the schistosomiasis and non-schistosomiasis groups were not detected despite assumptions about the effect of schistosomiasis on baseline haemoglobin due to sequestration and iron deficiency [17]. It is important to note that our findings represent associations only, and the cross-sectional design does not allow us to infer causality or assess long-term outcomes. These limitations should be considered when interpreting our results.
