Esophageal varices

When your esophageal or stomach blood vessels are expanded, they are termed as varices. They appear like swollen veins in the lining of the lower esophagus. These varices resemble the varicose veins that some people have in their legs. It is a chronic condition which can last for years or life time. In severe cases, they get swollen and rupture that ultimately leads to bleeding (esophageal varices bleeding).

Esophageal varices usually occur in the people who have a history of cirrhosis. Esophageal varices develop in almost 8% of patients who have chronic liver disease. The risk of bleeding is 30% after the first year of diagnosis.

Symptoms

Esophageal varices symptoms do not shoot up in early stages. The symptoms usually are seen when the case is bleeding.

  • You may feel dizzy
  • There can be vertigo or lightheadedness
  • You may pass bloody or dark colored stools
  • In severe cases, you may lose your consciousness

In the provisional diagnosis, your doctor may suspect varices if you have signs of liver disease such as:

  • Bleeding
  • Bruising
  • Fluid buildup in the abdomen
  • Yellow discoloration of white in the eyes

Bleeding from esophageal varices is life-threatening. If you notice any signs of bleeding such as blood in vomit or stool, then you must immediately call your doctor. If not you may become a victim of low blood pressure which ultimately makes you go into shock.

Risk factors

The factors that increase your risk for portal hypertension which leads to variceal bleeding later are:

  • Liver disease
  • Malnourishment
  • Circadian rhythms
  • Bacterial infections
  • Alcohol consumption
  • Lack of physical activity
  • Certain medications (NSAIDs, aspirin)

Complications

Bleeding is the most serious complication of esophageal varices. If you had an experience of a bleeding episode, then your risk of another bleeding episode highly increases. Too much of bleeding can make you go into shock, coma, and finally death.

Your doctor would detect the presence of esophageal varies with the help of following diagnostic tests:

Upper endoscopy

This procedure gives the complete view of esophageal and stomach lining. It is the most common way used to detect varices in the esophagus.

In the case of absence of varices your doctor would recommend for a re-diagnosis in three years. If the varices are present, then your doctor would recommend the endoscopy every one to two years for monitoring the enlargement of the varices.

Capsule endoscopy

This procedure is used less likely when compared to the upper endoscopy. It can be used as an alternative for upper endoscopy. Here, you will be asked to swallow a capsule that transmits photographs of the lining of the esophagus and stomach. Your clinician then reviews the photographs for determining the presence of any abnormalities.

Imaging tests

CT scans and Doppler ultrasounds of the splenic and portal veins can detect the presence of esophageal varices.

Treatment does not stop bleeding from the esophageal varices. It is a life-threatening emergency. The esophageal varices treatment can only reduce the risk of recurrence.

If there is any evidence of bleeding due to the rupture if varices, then one or two endoscopic treatments may be helpful

Band ligation : The vein which is bleeding is tied off with the help of a rubber band which is placed around the varices in the esophagus, this is also called as esophageal varices banding.
Sclerotherapy: To allow a blood clot formation and to reduce the bleeding, a drug is injected into the bleeding vein, making it narrow
Transjugular Intrahepatic portal-systemic shunt (TIPSS): This treatment helps in reducing the excess pressure created in the esophageal varices, and decreases the risk of bleeding even in future.
Surgical intervention: This is of last priority; rarely might you need the surgery to create a shunt for diverting the excess blood in the portal vein from the liver to another vein. This helps in reducing the pressure in the varices.

Anything which causes portal hypertension could be a cause for esophageal varices. Portal hypertension occurs due to the blood pressure in the portal vein as a hallmark of cirrhosis. When the portal vein is under pressure, it affects the nearby veins that results in esophageal varices.

Prehepatic causes Intrahepatic causes Posthepatic causes
  • Portal vein thrombosis
  • Myelosclerosis
  • Budd-Chiari syndrome
  • Increase in the spleen flow
  • Acute hepatitis
  • Right-sided heart failure
  • Increase in the portal blood flow
  • Schistosomiasis
  • Compression caused by any tumor
  • Obstruction of the portal vein
  • Hepatic fibrosis by birth