* Corresponding author: Salem Mohamed, Internal Medicine Department, Zagazig University, Egypt. Email: salemyousefmohamed@gmail.com © 2016 mums.ac.ir All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Can Patients with Chronic Liver Diseases Withstand Ramadan Fasting? Salem Mohamed 1 *, Mohamed Emara 2 1. Assistant Professor of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt 2. Assistant Professor of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt A R T I C L E I N F O A B S T R A C T Article type: Short communication Article History: Received: 13 Nov 2016 Accepted: 03 Dec 2016 Published: 10 Dec 2016 Please cite this paper as: Mohamed S, Emara M. Can Patients with Chronic Liver Diseases Withstand Ramadan Fasting? (Short Communication). J Fasting Health. 2016; 4(4): 122-123; DOI: 10.22038/jfh.2016.7931 Communication Ramadan is a holy month for Muslims all around the world. During this lunar-based month, healthy adult Muslims are obligated to abstain from eating, drinking, smoking, or using oral medications from predawn to sunset. Followers will typically eat just after sunset (Iftar; the first meal served to daytime fasting followers) and again before dawn (Sohor; last meal followers eat before the beginning of fasting) and they can eat in between (1). The Islamic lunar Hijri calendar is 11 days shorter than the Gregorian solar calendar, and therefore, the month of Ramadan can occur in any season of the year. The hours spent on fasting can vary from 12 to 18 h, depending on the seasonal and regional features, and this ultimately will affect the ability of individuals and patients to fast. In the North Pole, the day time is very long and may reach up to 22 hours; toward the equator the temperature and humidity are high. These entire environmental factors directly decrease the ability of patients to complete one month of continuous fasting. The studies focusing the impact of fasting during Ramadan on different liver diseases are scarce (2,3) and that is why no structured guidelines for fasting and liver diseases(4) have been set up. We conducted a prospective observational study (5) to shade the light on the impact of fasting during Ramadan in the summer time on liver cirrhosis and portal hemodynamics. We followed 40 cirrhotic patients who intended to fast during the summer of 2014 through the whole month of Ramadan. Our patients were examined by Congestion index (CI) of the portal vein 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. These tests were done at baseline just before they began fasting and immediately after finishing the wholly month while CI was done during fasting and after iftar to evaluate portal flow changes. Our patients were advised to postpone sohor to the last time, do not delay iftar, also were kept on the nutritional support of branched chain amino acids during night time, besides avoiding daytime diuretic therapy. A total of 38 patients completed the whole month fasting and two patients discontinued fasting due to the development of variceal bleeding. The total number of complicated patients in our cohort were 7 patients, these included development of lower limb edema, increasing ascites, increasing jaundice and development of overt hepatic encephalopathy and 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.