Esophageal Varices

Esophageal varices are dilated veins in the esophagus that dilate because there is cirrhosis of the liver. When the liver is cirrhotic, it fails to be able to pass blood from the portal vein into the liver. The portal vein has an increase in pressure and this results in varicose veins in the abdomen and around the esophagus. Esophageal varices have no obvious symptoms unless they become irritated and bleed. When they bleed, the bleeding can be brisk and the individual can suffer from shock and imminent death. The bleeding often results in the vomiting of bright red blood. This is a medical emergency and you need emergency treatment as soon as possible.

Cirrhosis is the main cause of esophageal varices. It happens in those with alcoholic cirrhosis as well as cirrhosis as a result of hepatitis B, C and other types of chronic hepatitis. The severe bleeding can be a result of eating something that causes the esophageal varices to rip or tear. It also can happen when the pressure inside the portal venous system gets to a high enough level. Certain other liver diseases that cause poor blood flow through the liver can cause esophageal varices to occur. Varices can occur in the esophagus and in the upper portion of the stomach as well.

As mentioned, there are few symptoms of esophageal varices that are not bleeding. If they bleed just a little, you can get tarry, black stools or maroon-colored stools from the blood interacting with stool and digestive juices. There can be grossly bloody stools as well. If the bleeding is profuse, you can get vomiting of bright red blood, paleness and light-headedness. You can faint or pass out from this condition and some people can die within a few moments of having this kind of bleeding. This is why it is such a serious disease.

Doctors can evaluate you for the presence of esophageal varices. There can be a positive occult blood in the stool test and positive occult blood showing up in the emesis. The blood pressure is often low due to rapid bleeding and the heart rate is rapid as the heart tries to make up for the lost blood. You can have ascites (fluid in the abdomen) from cirrhosis. This looks like a distended abdomen that is large and out of proportion to the rest of the body.

An EGD test can show the presence of esophageal varices. EGD stands for esophagogastroduodenoscopy and is an endoscopic test that looks with a camera at the esophagus and stomach. The esophageal varices will show up as varicose veins beneath the lining of the esophagus. Any bleeding spots will show up as well and can be treated with sclerotherapy or patching of the bleeding area.

In the absence of an endoscope, you can pass a nasogastric tube down into the esophagus to look for signs of bleeding. This must be done carefully because the esophageal varices tend to be very friable and should not be further damaged. The nasogastric tube is a lesser means of detecting blood in the esophagus because you can easily mistake stomach bleeding from esophageal variceal bleeding.

It is crucial to stop the acute bleeding from esophageal varices as soon as conceivably possible because the bleeding is often quite brisk. Treatment is usually done through an endoscope and involves using the scope to put bands around the bleeding areas so they stop bleeding. A sclerosing or clotting medication can be used to clot the varicose vein and stop bleeding immediately. Medications, such as ocreotide or vasopressin can be used to spasm the blood vessels and bring up the blood pressure. In some cases, a balloon can be passed through the esophagus connected to a tube. The balloon is blown up and the bleeding is stopped. This is a temporary measure and requires that the blood clot in the varices over several hours. Unfortunately, those with liver cirrhosis often have bleeding and clotting problems and will need some clotting factors or fresh frozen plasma in order to allow for clotting of the varices.

When the bleeding has stopped, doctors use beta blocker medications to lower the blood pressure and to decrease the bleeding risk. Bands can be placed around the varices and a shunt can be placed that bypasses the varices and the liver so that the pressure in the esophageal veins is reduced. The shunt is called a transjugular intrahepatic portosystemic shunt or TIPS.