Esophageal Varices

Esophageal Varices

What are esophageal varices?

Esophageal varices are swollen veins in the filling of the lower esophagus near the stomach. Swollen veins in the esophagus or stomach are related to varicose veins in some legs. Because the veins in the esophagus are so close to the surface of the esophagus, the swollen veins in this area can rupture and cause dangerous bleeding.

Esophageal varices almost always occur in people with cirrhosis of the liver. Cirrhosis causes scarring of the liver, which reduces blood flow through the liver. Scarring causes blood to pool in the portal vein, the main vein that supplies blood to the liver from the stomach and intestines. This “back up” causes high blood pressure in the portal vein and nearby veins. This is called portal hypertension.

Alternate name

  • Esophageal varix
  • Oesophageal varices

Causes of esophageal varices

When pressure increases in the veins that carry blood to the liver, it is called portal hypertension. Stress causes blood to flow back into other small blood vessels. It contains what is found in the esophagus. This leads to variations.

The main causes of these conditions are:

  • Cirrhosis of the liver
  • Blood clots of the splenic, portal, or hepatic veins
  • Abnormal relationships within the arteries and veins in the liver or spleen
  • Certain infections
  • Severe heart failure
  • Hodgkin lymphoma
  • Sarcoidosis

Risk factors for esophageal varices

Any liver disease increases a person’s risk of developing esophageal variations, although cirrhosis is the most common cause. Cirrhosis is less common in people with non-liver disease.

Cirrhosis and portal hypertension are the most usual conditions of esophageal varices. Both are possible complications of liver disease.

The main risk factors for esophageal varices include:

  • Obesity
  • Hepatitis infection
  • Alcohol misuse

Symptoms of esophageal varices

Symptoms of esophageal varices develop when bleeding begins. Symptoms that may appear are:

  • Vomiting up blood (hematemesis)
  • Dark stools (melena)
  • Yellow discoloration of eyes and skin (jaundice)
  • Loss of consciousness
  • Nausea and vomiting
  • Ascites (fluid accumulation in the abdomen)

Diagnosis of esophageal varices

An exam called an upper endoscopy may be done to check for esophageal varices. The doctor will insert a thin, flexible tube into your mouth, under your throat, and into your esophagus. The tube (called an endoscope) has a camera and a light, which the doctor can see into your esophagus and stomach. This can be done in our endoscopy center to facilitate IV (intravenous) anesthesia. Sometimes doctors perform the test using a small capsule with a small chamber inside. The capsule sends photos of the lining of your esophagus and stomach to a device outside of your body. Then a doctor will see if there are any problems with the photos.

Treatment for esophageal varices

The main goal of treating esophageal varices is to prevent tears and bleeding. Initially, it often involves steps to control portal blood pressure. Treatment includes 1 or more of the following:

  • Medicines: They can be prescribed to lower blood pressure within dilated veins. This reduces the risk of bleeding. The most widely used drug in beta-blockers.
  • Endoscopic therapy: These are treatments for enlarged or bleeding veins that are done with an endoscope. With a bandage, small rubber bands are placed around the veins to close them and stop the bleeding. With sclerotherapy, a blood-clotting drug can be injected into the veins to form and shrink scars.
  • Balloon tamponade: The tube containing the balloon is inserted into the esophagus and stomach. The balloon is then inflated. Put pressure on enlarged or bleeding veins to control bleeding. This is a short-term (temporary) way to maintain bleeding until different treatments are available.
  • Surgery: This can be done to place a tube-shaped device (stent) in the liver. The stent helps bypass blood flow to the liver to lower blood pressure in the dilated veins. Sometimes dilated veins connect with other nearby veins to divert blood flow. In difficult cases, a liver transplant may be essential. For this surgery, the diseased liver is replaced with a healthy liver from another person.

Prevention

  • Don’t drink alcohol
  • Eat a healthy diet
  • Keep a healthy weight
  • Use chemicals sparingly and carefully
  • Reduce your risk of hepatitis

Complications

The most serious complication of esophageal varices is bleeding. Once you have a bleeding episode, the risk of another bleeding episode increases dramatically. If you lose blood, you can go into shock, which can lead to death.

Prognosis

Bleeding is a very serious problem for esophageal varices. Patients treated for early-stage esophageal varices may experience recurrent bleeding within one to two years after treatment. This condition can be fatal if there is a great loss of blood due to bleeding from enlarged varices.

Without hospitalization, esophageal varices bleeding cannot be controlled. This is a fatal emergency. Early-stage bleeding is at least 50% of patients diagnosed with esophageal varices who have an increased risk of subsequent bleeding. This condition can be prevented with proper medication and endoscopy.

Departments to consult for this condition

  • Department of Gastroenterology

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