Background: Chronic liver disease is endemic in Pakistan with esophageal variceal bleeding as one of the important complications and is treated with EVBL. The early esophageal variceal rebleeding is one of the ignored factors which carries the high mortality and morbidity. Patients and methods: This case-control study was conducted in the Gastroenterology Department at Jinnah Hospital, Lahore, from February 2016 to February 2017. The Study included total 100 patients and out of these 50 were rebleeding cases while 50 were controls (without esophageal rebleed). Cases and control were matched for age, sex, Presence of hepatitis B and C and cirrhosis. The endoscopic findings of any active bleed and white nipple sign was recorded. Results: In this study, association of risk factors for prediction of early variceal rebleed after banding in cirrhotic hepatitis b and c patients with variceal bleed was recorded as 58%(n=29) in cases and 12%(n=6) for active bleeding, O.R was 10.12, 68%(n=34) in cases and 14%(n=7) in controls had nipple sign, O.R was 13.05, Hb level <9 g/dl was recorded in 88%(n=44) in cases and 40%(n=20) in controls, O.R 11.00, PT>18 sec was recorded in 96%(n=48) in cases and 4%(n=2) in controls, O.R was 576.00. Conclusion: Active bleeding and nipple sign, Hb level < 9 g/dl and PT > 18 sec are found to have strong association for prediction of early variceal rebleed after EVBL in cirrhotic hepatitis B and C patients.

Hereditary hemochromatosis is an autosomal recessive disorder characterized by dysregulated iron homeostasis resulting in body iron overload. Hemochromatosis leads to excessive iron deposition in the parenchymal cells of different body organs, resulting in the compromise of their normal functioning in genetically predisposed patients. It presents in genetically predisposed male patients aged between 40 and 70 years. Various mutations have been described in hemochromatosis, C282Y is the most prevalent and is commonly associated with iron overload. Other mutations such as H63D and S65C rarely lead to iron overload in patients. We present an unusual case of an 84-year-old male who was referred for comprehensive evaluation. He was found to have mildly elevated liver function tests (LFTs). Further workup revealed raised ferritin levels, and on a detailed investigation, it was found to be homozygous for the H63D mutation for hemochromatosis. The patient was seen by hematology and was treated with therapeutic phlebotomy, which led to the normalization of the LFTs and improvement in ferritin levels and clinical symptoms.