Epidemiology of chronic liver disease in Sudanese children Dr. Omaima M. Sabir Pediatric Gastroenterologist Khartoum, Sudan

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

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.

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

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.

Results 315 children were biopsied. Diagnosis M:F 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

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

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 Miscellaneous 70 TOTAL

Causes of CLD in age group from 5 – 15 years NO Causes 60 Liver cirrhosis 23 Infectious hepatitis 10 Periportal fibrosis 7 Autoimmune hepatitis Hepatocellular carcinoma Metabolic liver diseases 2 Progressive familiar intrahepatic cholestasis 1 Miscellaneous 120 TOTAL

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 don’t usually survive into older age.

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.

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.

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.