Table 1.

The effects of Ramadan fasting in cirrhotic patients.

Author Year	Study Design	Study Population	Number of Patients	Results
Elnadry et al., 2011 [23]	Observational and comparative	Chronic hepatitis and Cirrhotics (Child A and B)	N = 202 Fasting: 103 patients (57 chronic hepatitis, 46 cirrhotics). Non-fasting: 99 patients (52 chronic hepatitis, 47 cirrhotics)	Dyspeptic symptoms were higher in fasting group Gastrointestinal bleeding during Ramadan was higher in fasting group compared to non-fasting, but the variceal bleeding was significantly higher in the non-fasting group Chronic hepatitis fasting group showed non-significant changes pre, during and post Ramadan regarding liver functions. In the fasting cirrhotic group, the decompensation to Child C class developed both during and after Ramadan fasting
Elfert et al., 2011 [24]	Observational and non-comparison	Cirrhotics (Child A, B and C)	N = 216	BMI, serum glucose, ALT, AST, GGT, and ALP decreased Serum bilirubin increased significantly after full Ramadan fast Male sex, Child Pugh Class A and absence of gastrointestinal bleeding bleeding were independent factors in reduction in liver enzymes and serum glucose during Ramadan fasting Older age, Diabetes mellitus status and Child Pugh Class C were independent factors for elevation of serum bilirubin and creatinine during Ramadan fasting Twenty seven patients discontinued their fast due to fatigue Variceal bleeding and encephalopathy reported in eight and six patients, respectively Ramadan fasting had no significant effect on PV diameter or portal blood flow
Mohamed et al, 2016 [25]	Observational and non-comparison	Cirrhotics (Child A, B and C)	N = 40	Cirrhotic patients showed significant short-term increases in the congestive index as a non-invasive marker of the portal blood flow After Ramadan, there was a statistically significant increase in bilirubin and a decrease in albumin in Child Pugh Class C In patients with Child Pugh Class A and B there was no significant change in bilirubin, albumin level, prothrombin concentration or the degree of ascites, encephalopathy or upper GI bleeding events before and after Ramadan Shifting towards more advanced stage of Child class was due to lower limb edema development, increased ascites, increased jaundice and development of overt hepatic encephalopathy In total, seven patients developed complications with two cases of variceal bleeding
Mohamed et al., 2018 [26]	Observational and comparative	Cirrhotic (Child A and B) and healthy volunteers	N = 72 Cirrhotic fasting (N = 34), Cirrhotic non-fasting (n = 8) Healthy volunteers fasting (N = 30)	Patients with cirrhosis showed changes in their portal hemodynamics with increased CI Although more increased in cirrhotic patients, the congestive index didn’t change when these patients fasted MELD score and serum albumin showed significant changes in comparison to healthy subjects but no differences between cirrhotic patients that fasted or not

BMI: body mass index, AST: aspartate aminotransferase, ALT: alanine transaminase, GGT: gamma-glutamyl transferase, ALP: alkaline phosphatase, CI: congestive index.