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Esophageal Varices

Esophageal Varices is when the Sub-mucosal (connective tissue) veins in the lower third of the esophagus are abnormal and swollen in the lining of the esophagus. If left untreated, Esophageal Varices may rupture and lead to life-threatening bleeding. Esophageal varices are usually a consequence of portal hypertension, commonly found in cirrhosis of the liver patients. Esophageal varices have a strong tendency to bleed and/or produce black, tarry or bloody stools.

Causes of Esophageal Varices

Increased pressure in the veins that deliver blood to the liver leads to the formation of esophageal varices. This increased pressure causes blood to back up into other smaller vessels.

  • NAFLD – non-alcohol fatty liver disease
  • Chronic Hepatitis C or B
  • Alcohol abuse
  • Any chronic liver disease that leads to cirrhosis

Symptoms of Esophageal Varices

  • Vomiting or coughing up blood
  • Red, tarry, or very dark stools
  • Low blood pressure
  • Dizziness
  • Rapid heartbeat

Diagnosis of Esophageal Varices

  • Blood tests – blood test, liver and kidney function, and coagulations tests
  • Ultrasound – to study blood flow
  • Endoscopy – a small flexible tube with a light and camera inserted into the mouth to the esophagus and stomach to investigate for bleeding and swollen vessel.

Treatment of Esophageal Varices

  • Endoscopic Band Ligation – where a rubber band is tied around the bulging veins to prevent ruptures or stop bleeding.
  • Drug Therapy – is used to relieve blood pressure.
  • Transjugular Intrahepatic Portosystemic Shunting (TIPS) – involves threading a catheter from a neck vein to the liver. A stent, a small tube to keep veins open, is tied to the catheter and inserted into the liver to increase blood flow through the portal vein and relieve blood pressure in the esophageal varices. This procedure can control bleeding in over 90% of cases.

Prevention of Esophageal Varices

  • Seek early treatment for all liver conditions such as chronic hepatitis or fatty liver
  • Seek treatment for alcohol abuse if present
  • Use of beta-blockers (propranolol or nadolol) could prevent recurrent bleeding.