Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 38; pp. 13993 - 13998
• Main Authors: Camus, Marine, Jensen, Dennis M, Matthews, Jason D, Ohning, Gordon V, Kovacs, Thomas O, Jutabha, Rome, Ghassemi, Kevin A, Machicado, Gustavo A, Dulai, Gareth S
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14-10-2014
• Subjects: Adult; Aged; bleeding; California - epidemiology; Databases, Factual; Diagnosis, Differential; End; End Stage Liver Disease - complications; End Stage Liver Disease - diagnosis; End Stage Liver Disease - mortality; End Stage Liver Disease - therapy; Epistaxis; Epistaxis - diagnosis; Epistaxis - etiology; Epistaxis - mortality; Epistaxis - therapy; Female; gastrointestinal; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - mortality; Gastrointestinal Hemorrhage - therapy; Hemostatic Techniques; Hospital Mortality; Humans; Liver Transplantation; Male; Middle Aged; Multiple Organ Failure - etiology; Multiple Organ Failure - mortality; Observational Study; Predictive Value of Tests; Prevalence; Registries; Retrospective Studies; Risk Factors; Severity of Illness Index; stag; Treatment Outcome; Upper; California; Upper gastrointestinal bleeding; Cirrhosis; Epistaxis; Nasal packing; Nasogastric tube; End stage liver disease; Digestive bleeding; Coagulopathy; Liver transplantation
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i38.13993

AIM:To describe the prevalence,diagnosis,treatment,and outcomes of end stage liver disease(ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage(UGIH).METHODS:This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.RESULTS:A total of 1249 patients were registered for severe UGIH in the data basis,461(36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen(75%) subjects required posterior nasal packing and 2(10%) embolization in addition to correction of coagulopathy. Five(25%) patients died in the hospital,12(60%) received orthotopic liver transplantation(OLT),and 3(15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.CONCLUSION:Severe epistaxis in patients with ESLD is(1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH;and(2) associated with a high mortality rate in patients not receiving OLT.