Jerez Diaz D, Twohig P. Deadly intersection: Schistosomiasis, hepatopulmonary syndrome, and cirrhosis. World J Hepatol 2025; 17(4): 105583 [DOI: 10.4254/wjh.v17.i4.105583]
Corresponding Author of This Article
Patrick Twohig, MD, Assistant Professor, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14682, United States. patrick_twohig@urmc.rochester.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2025; 17(4): 105583 Published online Apr 27, 2025. doi: 10.4254/wjh.v17.i4.105583
Deadly intersection: Schistosomiasis, hepatopulmonary syndrome, and cirrhosis
David Jerez Diaz, Patrick Twohig
David Jerez Diaz, Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL 34239, United States
Patrick Twohig, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14682, United States
Author contributions: Jerez DJ and Twohig P contributed to this paper; Twohig P designed the overall concept and outline of the manuscript; Jerez D contributed to the discussion and design of the manuscript; Jerez D and Twohig P both contributed to the writing, editing of the manuscript, and review of the literature.
Conflict-of-interest statement: David Jerez and Patrick Twohig have nothing to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Patrick Twohig, MD, Assistant Professor, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14682, United States. patrick_twohig@urmc.rochester.edu
Received: January 30, 2025 Revised: March 3, 2025 Accepted: March 12, 2025 Published online: April 27, 2025 Processing time: 87 Days and 5.5 Hours
Abstract
In this editorial, we comment on the article by Rolim et al in World Journal of Hepatology, which highlights the impacts of hepatopulmonary syndrome (HPS) related to schistosomiasis in patients with and without cirrhosis. Schistosomiasis, a parasitic disease affecting millions worldwide, frequently leads to portal hypertension. Its outcomes are more devastating in cirrhosis than in non-cirrhotic portal hypertension, due to the complex interplay between cirrhosis and HPS, a severe pulmonary vascular complication. Cirrhosis distorts hepatic architecture, impairs portal blood flow, and triggers systemic vascular changes. Schistosomiasis exacerbates portal hypertension and inflammation, further injuring the liver. In non-cirrhotic portal hypertension, significant vascular resistance occurs, but preserved liver function mitigates systemic effects. In contrast, cirrhosis amplifies hypoxia, worsens pulmonary shunting, and predisposes patients to respiratory failure, infection, and death. In a retrospective study of 113 patients, Rolim et al found that cirrhosis had an impact on mortality, yet the presence of HPS did not significantly affect survival. While cirrhosis worsening outcomes are anticipated, HPS should theoretically worsen survival by impairing oxygenation. Early diagnosis, parasite control, and managing cirrhosis-related complications are critical for schistosomiasis-related liver disease. Understanding these differences underscores the importance of integrating liver health into global schistosomiasis management strategies.
Core Tip: Schistosomiasis, hepatopulmonary syndrome, and cirrhosis represents a perfect storm of pathophysiological complexity which can significantly worsen survival in those infected and with liver disease. Diagnostic and therapeutic challenges abound in disproportionately affected resource-limited settings where advanced imaging, pulmonary function testing, and liver transplantation may be scarce or unavailable.
