Esophageal Varices – Causes, Symptoms and Treatment
Esophageal varices are abnormally enlarged veins in the wall of the esophagus, commonly caused by liver cirrhosis, and can lead to life-threatening bleeding.
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Esophageal varices are abnormally enlarged veins in the wall of the esophagus, commonly caused by liver cirrhosis, and can lead to life-threatening bleeding.
What Are Esophageal Varices?
Esophageal varices are abnormally dilated veins located in the wall of the esophagus (the tube connecting the throat to the stomach). They develop when blood pressure in the portal venous system – which carries blood from the intestines to the liver – becomes significantly elevated. This condition is known as portal hypertension. Because the walls of these enlarged veins are thin and fragile, they are highly susceptible to rupture, which can result in severe, life-threatening hemorrhage.
Causes
The most common cause of esophageal varices is liver cirrhosis, a condition in which normal liver tissue is progressively replaced by scar tissue, increasing resistance to blood flow through the liver. As a result, blood is redirected through alternative pathways, including the veins of the esophagus.
- Liver cirrhosis (most common cause – due to chronic alcohol use, hepatitis B or C)
- Portal hypertension from other causes (e.g., portal vein thrombosis, Budd-Chiari syndrome)
- Right-sided heart failure causing backflow into the portal system
- Rare: congenital vascular abnormalities
Symptoms
Esophageal varices typically cause no symptoms in their early stages. The primary danger is acute bleeding, which may manifest as:
- Sudden vomiting of blood (hematemesis) – bright red or coffee-ground appearance
- Black, tarry stools (melena), indicating upper gastrointestinal bleeding
- Dizziness, sweating, drop in blood pressure, or shock
- Signs of underlying liver disease (jaundice, ascites, fatigue)
Diagnosis
The standard method for diagnosing esophageal varices is esophagogastroduodenoscopy (EGD) – an endoscopic procedure in which a flexible camera is passed through the mouth into the esophagus. This allows direct visualization of varices, assessment of their size, and identification of signs of recent or imminent bleeding.
- Endoscopy (EGD): gold standard for diagnosis and grading
- Ultrasound / Doppler sonography: evaluation of portal pressure and liver morphology
- CT angiography: used when vascular causes are suspected
- Laboratory tests: liver enzymes, coagulation parameters, complete blood count
Treatment
Acute Bleeding
An acute variceal bleed is a medical emergency requiring immediate intensive care management:
- Endoscopic band ligation (EBL): placement of rubber bands around varices to cut off blood flow – first-line treatment
- Sclerotherapy: injection of a sclerosing agent directly into the varix
- Vasoactive drugs (e.g., terlipressin, somatostatin analogues): reduce portal pressure
- Balloon tamponade (e.g., Sengstaken-Blakemore tube): temporary mechanical compression for uncontrolled bleeding
- TIPS (transjugular intrahepatic portosystemic shunt): a radiological procedure that creates an internal bypass to reduce portal pressure
Prevention (Primary and Secondary Prophylaxis)
To prevent a first bleeding episode or recurrence, the following strategies are used:
- Non-selective beta-blockers (e.g., propranolol, carvedilol): reduce portal pressure pharmacologically
- Regular endoscopic surveillance and ligation of large varices
- Treatment of the underlying condition (e.g., alcohol abstinence, antiviral therapy for hepatitis)
Prognosis
Prognosis depends largely on the severity of the underlying liver disease and the degree of portal hypertension. Acute variceal bleeding carries a high mortality rate – up to 20% per bleeding episode. Regular screening and consistent management of the underlying liver condition are essential to reduce the risk of bleeding.
References
- de Franchis R et al. – Baveno VII: Renewing consensus in portal hypertension. Journal of Hepatology, 2022; 76(4): 959–974.
- Garcia-Tsao G, Bosch J – Management of Varices and Variceal Hemorrhage in Cirrhosis. New England Journal of Medicine, 2010; 362(9): 823–832.
- European Association for the Study of the Liver (EASL) – Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 2018; 69(2): 406–460.
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Related search terms: Esophageal Varices + Oesophageal Varices + Esophageal Varicosities