esophageal varix

What are Esophageal Varices?

Esophageal varices are swollen or enlarged veins in the lining of the esophagus, which is the tube that connects the mouth and stomach. These veins can become dilated due to increased pressure from blood flowing through them, often as a result of liver disease.

Causes and Risk Factors

The main cause of esophageal varices is portal hypertension, which occurs when scar tissue blocks the flow of blood around the liver. This leads to high blood pressure in the portal vein, causing blood to be diverted through veins in the stomach or esophagus instead. Liver disease, particularly cirrhosis, is a common underlying condition that can lead to this complication.

Symptoms and Complications

Esophageal varices are often asymptomatic until they rupture, leading to severe bleeding. This can be life-threatening if left untreated. Other complications may include difficulty swallowing or chest pain.

Key Facts

• Esophageal varices are a common complication of liver disease.
• They occur when veins in the esophagus become dilated due to increased pressure from blood flow.
• Rupture of these veins can lead to severe bleeding, which is often life-threatening if left untreated.
• Symptoms may include difficulty swallowing or chest pain.

References

1. [1] Esophageal varices are swollen veins in the lining of your esophagus. You can’t see or feel them, but it’s important to know if they’re there because they pose a risk of rupture and internal bleeding. They usually occur with liver disease.
2. [3] Varices are enlarged veins that may be found in the esophagus in people with cirrhosis of the liver.
3. [5] Esophageal varices are enlarged veins in the esophagus, which can cause major bleeding.
4. [9] Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus.
5. [11] Esophageal varices are enlarged veins in the esophagus. When these veins become blocked, they restrict blood flow to the liver.
6. [13] Definition. Esophageal varices are dilated collateral blood vessels that develop as a complication of portal hypertension, usually in the setting of cirrhosis.

Common Signs and Symptoms of Esophageal Varices

Esophageal varices can cause a range of symptoms, which can vary in severity depending on the individual case. Here are some common signs and symptoms to look out for:

• Vomiting blood: This is one of the most distinctive symptoms of esophageal varices, where people may vomit bright red blood, sometimes in large amounts [1].
• Black, tarry stools: People with esophageal varices may also experience black, tarry stools due to the presence of digested blood in their stool [2].
• Lightheadedness and paleness: As the body loses blood, people may feel lightheaded or dizzy, and their skin may appear pale [3].
• Symptoms of chronic liver disease: Esophageal varices are often a complication of chronic liver disease, so symptoms such as jaundice, fatigue, and abdominal swelling may also be present [4].
• Decreased urine output and excessive thirst: As the body loses blood, people may experience decreased urine output and excessive thirst due to dehydration [5].

It's worth noting that esophageal varices can cause a range of other symptoms as well, including:

• Painless vomiting of blood
• Black, tarry or bloody stools
• Decreased urine output
• Excessive thirst
• Light-headedness
• Paleness
• Anemia

If you or someone you know is experiencing any of these symptoms, it's essential to seek medical attention immediately.

Diagnostic Tests for Esophageal Varices

Esophageal varices are swollen veins in the esophagus that can rupture and cause massive bleeding. To diagnose esophageal varices, several tests can be performed.

• Upper Endoscopy: This is the most common way to detect varices. During this procedure, a flexible tube with a camera and light on the end (endoscope) is inserted through the mouth and guided into the esophagus. The doctor can then visualize the varices and take biopsies if necessary [9].
• Endoscopy: This test is used to study blood flow in the esophagus and identify high-risk EV (medium or large EV, or small EV with red wale signs) [4].
• Ultrasound: An ultrasound can be used to study blood flow in the esophagus and abdomen area. It's a non-invasive test that uses sound waves to create images of the internal organs [10].
• CT Scans: Computed Tomography (CT) scans can also be used to diagnose esophageal varices, especially when liver disease or blood clots are suspected [5].
• Blood Tests: Blood tests such as complete blood count, coagulation profile (INR/prothrombin time), serum LFTs, BUN and creatinine can help identify underlying conditions that may be contributing to the development of esophageal varices [8].

These diagnostic tests are essential in identifying esophageal varices and determining the best course of treatment. Early detection is crucial in preventing complications such as massive bleeding.

References: [4] by S Pallio · 2023 · Cited by 24 — [5] Oct 12, 2021 — [8] 1st tests to order · hepatic venous pressure gradient (HPVG) · complete blood count · coagulation profile (INR/prothrombin time) · serum LFTs · BUN and ... [9] Mar 26, 2024 — Upper endoscopy — [10] Some tests used to diagnose esophageal varices include endoscopy, CT scans and ultrasounds of the abdomen area.

Esophageal varices are a common complication of liver cirrhosis, and drug treatment plays a crucial role in preventing and managing bleeding episodes.

Beta-blocker medications [3][12][13] are commonly used to prevent an episode of variceal bleeding by lowering the pressure in the enlarged veins (varices). These medications include:

• Propranolol
• Nadolol
• Carvedilol

These beta blockers reduce portal vein pressure and the risk of bleeding. They work by slowing down the heart rate and reducing blood flow to the liver, which helps to decrease the pressure in the varices.

Other medications [12][14] may also be used to prevent future bleeding episodes. These include:

• Blood transfusion: Replaces the blood lost due to bleeding
• Medications that slow blood flow from the esophagus to the liver
• Antibiotics to prevent bacterial infection in the esophagus

It's essential to note that while drug treatment can help manage esophageal varices, it is not a substitute for other treatments such as endoscopic band ligation (EVL) or sclerotherapy. A comprehensive treatment plan should be developed by a healthcare professional to ensure the best possible outcomes.

References:

[3] August 2, 2024 - The risk of mortality from your first episode of variceal bleeding is 20%. In 40% of cases, bleeding resolves spontaneously without treatment. In 90% of cases, treatment with band ligation controls the bleeding. However, the risk of new bleeding is 60%, regardless of treatment.

[12] December 31, 2023 - Once the bleeding is stopped, other varices can be treated with medicines and medical procedures to prevent future bleeding.

[13] Beta-blocker medicines are used to prevent an episode of variceal bleeding by lowering the pressure in the enlarged veins (varices).

[14] Blood transfusion: Blood from a donor replaces the blood you have lost. Medications: Beta blockers may reduce the pressure in your portal vein. Other medications may slow blood flow from your esophagus to your liver. Antibiotics are given to prevent a bacterial infection in the esophagus.

The differential diagnosis for esophageal varices includes several conditions that can present with similar symptoms or characteristics. Here are some of the possible differential diagnoses:

• Alcoholic gastritis: This is a condition where inflammation and irritation occur in the stomach lining, often due to excessive alcohol consumption. It can cause symptoms such as abdominal pain, nausea, and vomiting.
• Mallory-Weiss syndrome: This is a condition where tears or erosions occur in the mucous membrane of the esophagus or stomach, often due to intense or prolonged vomiting. It can cause symptoms such as bleeding, abdominal pain, and difficulty swallowing.
• Portal hypertensive gastropathy: This is a condition where there is increased pressure on the blood vessels in the stomach, often due to liver disease or portal hypertension. It can cause symptoms such as bleeding, abdominal pain, and difficulty swallowing.
• Peptic ulcer disease: This is a condition where ulcers form in the lining of the stomach or duodenum, often due to infection with H. pylori bacteria or use of nonsteroidal anti-inflammatory drugs (NSAIDs). It can cause symptoms such as abdominal pain, nausea, and vomiting.
• Gastric or duodenal varices: These are rare conditions where dilated blood vessels occur in the stomach or duodenum, often due to portal hypertension. They can cause symptoms such as bleeding, abdominal pain, and difficulty swallowing.

It's worth noting that esophageal varices are typically diagnosed through an esophagogastroduodenoscopy (EGD), which allows for visualization of the upper gastrointestinal tract and identification of any abnormalities. The differential diagnosis listed above should be considered in cases where esophageal varices are suspected, but not definitively diagnosed.

References:

• [8] lists Alcoholic gastritis as a differential diagnosis.
• [9] lists Mallory-Weiss syndrome, Portal hypertensive gastropathy, Peptic ulcer disease and Gastric or duodenal varices as differential diagnoses.
• [11] lists Acute gastric erosions and Duodenal ulcers as differential diagnoses of variceal hemorrhage which includes esophageal varix.