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Clinical Characteristics and Etiology of Chronic Liver Disease among Egyptian Patients in Nile Delta: A Clinical Study

Background: Chronic liver disease (CLD) is an extremely common clinical condition that causes significant morbidity and mortality and was responsible for 1.3 million deaths worldwide. There had been a 46% increase in CLD mortality in the world between 1980 and 2013 and most of this increase has been reported in low-income countries in Asia and Africa including Egypt. These countries are experiencing a demographic and epidemiologic transition in disease burden and Egypt is one of the epicenters of this change. Previously, CLD in Egypt was traditionally attributed to schistosomiasis mainly in the region of the Nile Delta until the mid-1980s. 
Aims: To capture the modes of clinical presentation and at which stage CLD patients seek clinical care, as well as the dramatic change in the etiological profile of CLD in this area of the Nile Delta 
Methods: 1013 newly diagnosed CLD patients were selected and identified from the Tanta Liver Center (TLC) across the middle of the Nile Delta. After informed or written consent, all consecutive patients (18 years and above) referred to TLC with suspected or overt chronic liver disease were subjected to full history taking, clinical examination searching for stigmata of chronic liver disease, and laboratory studies including urine, blood sugar, liver biochemical tests (bilirubin, ALT, AST& serum albumin), prothrombin, viral markers (HCV Ab & HBS Ag) and AFP. Imaging studies including the abdominal US for all patients and triphasic CT and liver biopsy in selected patients. 
Results: About 50% of our CLD patients present at a relatively advanced stage of decompensated cirrhosis (ascites in 39.2%, bleeding in 22.8%, and HCC in 9.3%). 
CLD patients of schistosomal etiology presented mainly with manifestations of portal hypertension (splenomegaly, UGI Bleed & thrombocytopenia) that was significantly higher than the other 2 groups. 
The vast majority of our CLD patients (83.5%) have viral etiology, while only 11.1% have schistosomal etiology and the remaining 5.4% have non-identified etiology. 
Conclusion: based on the results of the present study, it is evident that HCV had replaced schistosomiasis as the predominant cause of CLD in Egypt particularly in the region of the Nile Delta. The late presentation of a good percentage of our CLD patients raises the importance of screening programs for CLD in this endemic area of the Nile Delta.