Epidemiology of chronic liver disease in Sudanese children

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Epidemiology of chronic liver disease in Sudanese
children

• Dr. Omaima M. Sabir
• Pediatric Gastroenterologist
• Khartoum, Sudan

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Introduction

• Chronic liver diseases in Sudanese children are
  significant problem.
• The etiology of which have never been determined
  before.

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Objectives

• To determine the pattern of and the histological
  features of chronic liver diseases at Gaafer Ibn
  Auf Specialized children hospital in Khartoum
  over the last 3 years.

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Methodology

• Prospective study of all children under 15 years
  of age who underwent liver biopsies for
• Prolonged jaundiced for gt 6 weeks.
• Hepatomegaly.
• Persistent abnormal LFT.
• Portal hypertension.

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Methodology/2

• Clinical and laboratory data were received.
• All liver biopsies slides were received by two
  histopathologists and the author to confirm the
  diagnosis.
• All the biopsies were taken by U/S guidance
  technique using either true cut or suction needle
  according to the age and the clinical status of
  the child.

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Results

• 315 children were biopsied.

Diagnosis MF No Age
NH, BA,PFIC, syndromic non syndromic PDP, Metabolic LD 74 51 125 6/52 1 year
Fatty liver, viral infectious, metabolic, PFIC 49 21 70 1 5 years
Liver cirrhosis, viral infectious, AIH, HCC, Metabolic, PFIC 80 40 120 5 15 years
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Causes of chronic liver diseases in infancy
NO Causes
62 Neonatal Hepatitis
22 Billiary Atresia
21 Progressive familiar intrahepatic cholestasis
13 Metabolic liver diseases
12 Bile duct paucity (Syndromic non Syndromic)
5 Miscellaneous
125 TOTAL
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Causes of CLD in age group from 1 5 YEARS
NO Causes
29 Fatty liver diseases
20 Viral hepatitis
10 Tropical (infectious) hepatitis
5 Metabolic liver diseases
3 Progressive familiar intrahepatic cholestasis
3 Miscellaneous
70 TOTAL
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Causes of CLD in age group from 5 15 years
NO Causes
60 Liver cirrhosis
23 Infectious hepatitis
10 Periportal fibrosis
7 Autoimmune hepatitis
10 Hepatocellular carcinoma
7 Metabolic liver diseases
2 Progressive familiar intrahepatic cholestasis
1 Miscellaneous
120 TOTAL
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Discussion

• In infancy still neonatal hepatitis is the
  commonest pathology in our country, congenital
  hepatitis still encountered for the majority
  followed by sepsis.
• Billiary atresia is found to be high incidence
  compared to the developed country and usually
  presented quite late.
• Relevant high incidence of familiar hepatic
  disease due to consanguinity who they dont
  usually survive into older age.

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Discussion/2

• Fatty liver diseases compose of the majority of
  findings in the age group 1 5 years followed by
  viral and infectious hepatitis, which can be
  explained by malnutrition and endemicity of
  hepatitis B and C.
• Metabolic and hereditary liver diseases are
  obvious coming to small percentage could
  explain the natural survival.
• The astonishing findings of high incidence of
  liver cirrhosis in age group 5 15 years lead to
  the question.

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Discussion/3

• ? Fatty liver is not as innocent as we thought.
• ? Presence of specific type of childhood
  cirrhosis in our country.
• The impact of hepatitis B infection in our
  children.
• Periportal portal fibrosis surprisingly was not
  as high as one expected, but that could be mainly
  because we diagnose by sonography or it has been
  looked after by our adult colleague.
• Micronodular and mixed cirrhosis were the main
  types of cirrhosis which are identified.

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Conclusion

• Liver diseases have a major impact among our
  children.
• Late referral of prolonged neonatal jaundice.
• The possibility of specific type of childhood
  cirrhosis in Sudan.
• High incidence of hepatocellular carcinoma in
  Sudanese children.