Esophageal varices are enlarged, swollen veins in the lining of the lower esophagus, usually caused by obstructed blood flow through the portal vein, which carries blood from the digestive organs to the liver. This obstruction often results from severe liver disease, particularly cirrhosis. Esophageal varices pose a serious medical concern due to the risk of rupture and life-threatening bleeding.
The primary cause of esophageal varices is portal hypertension—an increase in blood pressure within the portal vein system. This condition most often develops due to liver cirrhosis, which can be the result of:
Chronic alcohol abuse
Hepatitis B or C infections
Fatty liver disease
Autoimmune liver conditions
Biliary cirrhosis
When the liver becomes scarred and hardened, it restricts normal blood flow, forcing blood to reroute through smaller, less durable veins, such as those in the esophagus. These veins are not built to withstand high pressure, leading them to swell and form varices.
Esophageal varices typically do not produce symptoms unless they rupture and bleed. However, certain signs may indicate their presence or an impending complication:
Vomiting blood (hematemesis)
Black or tarry stools (melena)
Lightheadedness or fainting due to blood loss
Signs of chronic liver disease such as jaundice (yellowing of skin and eyes), abdominal swelling (ascites), or spider veins
Paleness and fatigue, often due to anemia from blood loss
Shock, in severe bleeding cases, marked by rapid pulse, cold clammy skin, and confusion
These symptoms can escalate rapidly, and a ruptured varix constitutes a medical emergency requiring immediate treatment.
Doctors use endoscopy as the primary diagnostic tool. In this procedure, a flexible tube with a camera is inserted into the esophagus to directly observe varices. Imaging tests such as ultrasound, CT scans, and MRI can also help assess liver damage and portal hypertension.
The treatment of esophageal varices focuses on two key objectives: preventing rupture and managing bleeding if it occurs.
Preventive Measures:
Beta-blockers like propranolol or nadolol reduce portal pressure and the risk of bleeding.
Endoscopic variceal ligation (EVL) involves placing rubber bands around varices to reduce bleeding risk.
Lifestyle changes, such as abstaining from alcohol and maintaining a healthy diet, are vital for managing liver disease.
Bleeding Management:
Endoscopic therapy is performed urgently to control active bleeding, using band ligation or sclerotherapy.
Blood transfusions may be necessary to replace lost blood.
Vasoactive drugs help lower blood pressure in the portal vein during acute bleeding episodes.
Transjugular intrahepatic portosystemic shunt (TIPS) is a more advanced procedure that creates a pathway within the liver to reduce portal pressure.
Liver Transplantation:
For patients with end-stage liver disease, liver transplantation may be the only long-term solution to prevent recurrent variceal bleeding.
Avoid alcohol and hepatotoxic drugs, as they worsen liver damage.
Regular monitoring for those diagnosed with liver disease or portal hypertension.
Vaccination against hepatitis A and B.
Follow prescribed medication routines strictly.
Avoid strenuous activities or heavy lifting, which may increase intra-abdominal pressure.
Immediate medical attention is crucial if you experience:
Vomiting blood or passing black stools
Sudden dizziness or fainting
Severe abdominal pain
Signs of liver failure, including confusion, yellowing of the skin, or swollen abdomen
Routine consultation is advised if you have a known liver condition, to monitor and manage the risk of esophageal varices.
Esophageal varices are a serious complication of liver disease, particularly cirrhosis, and can lead to life-threatening bleeding. Understanding the signs, taking precautions, and adhering to regular medical follow-ups are key to preventing complications. Early diagnosis and proactive management can significantly improve outcomes and enhance quality of life.
+916123503100
Request An Appointment
