This Article has been received in 5 th February 2011. & accepted for publication in 10 th May 2011. 33 www.tantamsj.com Tanta Medical Sciences Journal Vol. (6), No. (3), July 2011: PP 33-25 P-ISSN: 1687- 5788 e-ISSN: 1687- 7918 Original Article A Multicenter Pilot Study of the Effects of Ramadan Fasting on Patients with Liver Cirrhosis Asem A. Elfert, 1 Sabry A. AbouSaif, 1 Nadia A. Abdel Kader, 2 Elsayed AbdelAal, 3 Ashraf Y. Elfert, 4 Amal T. Abdel Moez, 2 Hasan E. Elbatae, 1 Mohamed S. Kohla, 3 Raafat A. Salah 1 & Amr Elbadry 5 Department of Tropical Medicine 1 & Radiology 5 , Tanta University, 2 Department of Tropical Medicine, Ain Shams University, Departments of Hepatology 3 , National Liver Institute, Menoufiya University, 4 Clinical Biochemistry Department, National Liver Institute, Menoufiya University, Egypt ABSTRACT Background /Aim: Muslim patients with liver cirrhosis ask their doctors about Ramadan fasting. Indirect hyper bilirubinemia has been found to increase during fasting in Gilbert's syndrome. There are no available data on the effect of Ramadan fasting on patients with liver cirrhosis. The aim of this study was to evaluate the effects of Ramadan fasting on patients with liver cirrhosis. Patients & Methods: 300 patients with liver cirrhosis had been studied. Epidemiological, clinical, laboratory, and hemodynamic evaluation had been compared before and after fasting Ramadan 1431 Hijri calendar. Results: 216 patients completed the follow up period. BMI, serum glucose, ALT, AST, GGT, and ALP decreased; while serum bilirubin increased significantly after full Ramadan fast ( p<0.05). Male gender, Child class A and absence of GI bleeding had been independent factors in reduction of liver enzymes and serum glucose during fasting (p<0.05, CI=95%). Increasing age, diabetes mellitus and Child class C had been independent factors in elevation of bilirubin during fasting (p<0.05, CI=95%). Conclusion: Patients with Child A liver cirrhosis and no history of GI bleeding may benefit from fasting Ramadan. But, old patients with Child C cirrhosis associated with GI bleeding or diabetes mellitus should be advised not to fast. Larger prospective randomized controlled trials should be done to produce definite parameters for cirrhotic patients who can fast. Keywords: Pilot Study, Ramadan Fasting, Liver Cirrhosis. Corresponding author: Asem A. Elfert, Department of Tropical Medicine, Faculty of Medicine, Tanta University, Egypt. INTRODUCTION While fasting the holy month of Ramadan caught the interest of researchers in many fields of medicine, 1-9 there are no data on the effects of fasting Ramadan on patients with liver cirrhosis. Exacerbation of unconjugated hyper- bilirubinemia has been noticed in Muslim patients with Gilbert's syndrome. 10 An experimental study showed a tremendous adaptation capacity of both liver and intestinal metabolic activities with Ramadan-type fasting in rats. 11 The aim of our study was to evaluate the clinical, biochemical and hemodynamic effects