Changes in portal blood flow and liver functions in cirrhotics during Ramadan fasting in the summer; a pilot study.

TLDR: Cirrhotic patients showed significant short-term changes in the portal blood flow, however, these changes are not linked to complications or deterioration of liver functions and accommodated especially in patients with Child class A and B, who should not fast.

Abstract: Aim: Assessment of short term changes in portal blood flow and long term changes in liver functions in cirrhotic patients who chose to fast during the month of Ramadan in summer.Background: During Ramadan, healthy Muslims obligated to fast from predawn to sunset.Patients and methods: Forty cirrhotic patients intended to fast during the month of Ramadan in the year 2014, were examined by Congestion index (CI) as a non-invasive indicator of short term changes in the portal blood flow, while liver function tests were determined as an indicator of long term changes in liver functions.Results: A total of 38 patients completed the whole month fasting and two patients discontinued fasting due to variceal bleeding. The complicated patients were 7. CI showed a statistically significant increase from fasting to postprandial status (P <0.001), with statistically significant increases from fasting to postprandial status in Child class A (P <0.001), and B (P <0.001). We did not find a statistical significance between patients with complications and those without complications (P = 0.6). There was a statistically significant rise in the serum bilirubin after Ramadan. Deterioration noticed as advanced Child classes, development of lower limb edema, increasing ascites, increasing jaundice and overt encephalopathy.Conclusion: Cirrhotic patients showed significant short-term changes in the portal blood flow. However, these changes are not linked to complications or deterioration of liver functions and accommodated especially in patients with Child class A and B.  Child class C patients should not fast.