Esophageal Varices

Esophageal varices are enlarged veins in the esophagus, which is the tube that carries food from the mouth to the stomach. They are a complication of liver disease, most commonly cirrhosis, and can be life-threatening if they bleed.

Causes and Risk Factors

Esophageal varices are caused by increased pressure in the portal vein, which is the vein that carries blood from the intestines to the liver. This increased pressure, known as portal hypertension, can be due to a variety of factors, including:

• Cirrhosis: Scarring of the liver, often due to chronic liver disease or alcohol abuse
• Portal vein thrombosis: A blood clot in the portal vein
• Schistosomiasis: A parasitic infection that can cause scarring in the liver
• Non-cirrhotic portal fibrosis: A condition characterized by scarring in the portal vein without cirrhosis

Symptoms

The symptoms of esophageal varices may include:

• Vomiting blood or black tarry stools
• Abdominal pain or tenderness
• Bleeding from the rectum or anus
• Weakness, fatigue, or shortness of breath due to anemia from chronic bleeding

Diagnosis

Esophageal varices are typically diagnosed using:

• Endoscopy: A flexible tube with a camera and light on the end is inserted through the mouth to visualize the esophagus and stomach
• Imaging tests: Such as CT scans or MRI scans, which can help identify liver disease and portal hypertension

Treatment

The treatment of esophageal varices depends on the severity of the condition and may include:

• Medications: To reduce blood flow to the varices and prevent bleeding, such as beta blockers or nitrates
• Endoscopic therapy: Such as banding or sclerotherapy, which can help stop bleeding from varices
• Transjugular intrahepatic portosystemic shunt (TIPS): A procedure that creates a new pathway for blood to flow from the liver to the vena cava, reducing pressure in the portal vein
• Liver transplant: In severe cases of liver disease, a liver transplant may be necessary to prevent further complications

Prevention

To reduce the risk of developing esophageal varices, it is essential to:

• Manage underlying liver disease, such as cirrhosis or hepatitis
• Avoid excessive alcohol consumption
• Maintain a healthy weight and diet
• Get regular check-ups with a healthcare provider to monitor for signs of liver disease

Complications

If left untreated, esophageal varices can lead to serious complications, including:

• Bleeding: Which can be life-threatening if not treated promptly
• Anemia: Due to chronic bleeding from the varices
• Portal hypertensive gastropathy: A condition characterized by changes in the stomach lining due to increased pressure in the portal vein