Overview
Esophageal varices are enlarged veins in the esophagus, the tube that connects the throat and stomach. They usually form in people with serious liver diseases, such as cirrhosis, and occur when regular blood flow to the liver is blocked by clots or scar tissue in the liver. As a result, blood flows into smaller blood vessels that aren't designed to carry large volumes of blood, leading to potential bleeding from the varices. Symptoms of bleeding esophageal varices include vomiting large amounts of blood, black, tarry or bloody stools, lightheadedness due to blood loss, and loss of consciousness in severe cases. If you have been diagnosed with esophageal varices, it's important to watch for signs of bleeding and seek emergency medical attention if you experience black or bloody stools or bloody vomit.
Understanding the disease
Symptoms
The symptoms of esophageal varices include vomiting large amounts of blood, black, tarry or bloody stools, lightheadedness due to blood loss, and loss of consciousness in severe cases. These symptoms typically occur when the varices bleed. Esophageal varices usually don't cause symptoms unless they bleed. If you have been diagnosed with esophageal varices, it's essential to watch for signs of bleeding and seek emergency medical attention if you experience black or bloody stools or bloody vomit.
Risk Factors
The risk factors for developing esophageal varices include:
- Severe liver scarring, or cirrhosis, caused by various liver diseases such as hepatitis infection, alcoholic liver disease, fatty liver disease, and primary biliary cholangitis.
- Blood clot, or thrombosis, in the portal vein or splenic vein.
- History of bleeding from esophageal varices, as a person is more likely to have varices that bleed again. While many people with advanced liver disease develop esophageal varices, not all will experience bleeding. High portal vein pressure increases the risk of bleeding, and once a bleeding episode occurs, the risk of another episode increases significantly.
Development
Esophageal varices develop as a result of increased pressure within the portal vein, which carries blood to the liver. The pressure increase is often caused by scar tissue in the liver, known as cirrhosis, or a blood clot in the portal vein or its tributaries. As blood flow to the liver is obstructed, it finds alternative pathways through smaller veins, including those in the lower part of the esophagus. The increased blood flow causes these veins to enlarge, resulting in esophageal varices. The risk of bleeding from these varices is higher in individuals with high portal vein pressure, previous episodes of bleeding, or certain liver diseases.
Assessment and Diagnosis
Triage
You should see a doctor if you have symptoms that worry you, especially if you have signs of liver disease or have been diagnosed with liver cirrhosis. Symptoms that may indicate esophageal varices include yellow coloration of the skin and eyes (jaundice), easy bleeding or bruising, and fluid buildup in the abdomen (ascites). If you're experiencing any of these symptoms or have been diagnosed with liver disease, it's essential to consult your healthcare provider. They can assess your risk of esophageal varices and advise you on necessary precautions or treatments.
Diagnosis
The primary method of diagnosing esophageal varices is through an endoscopic exam, which involves inserting a flexible, lighted tube called an endoscope down the throat and into the esophagus. During the procedure, a healthcare provider examines the esophagus, stomach, and the beginning of the small intestine, looking for dilated veins. If found, the enlarged veins are measured and checked for red streaks and spots, which usually indicate a significant risk of bleeding. In addition to the endoscopic exam, imaging tests like abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices.
Management and Treatment
Complications
The most serious complication of esophageal varices is bleeding. Once you've had a bleeding episode, your risk of another bleeding episode greatly increases. If you lose enough blood, you can go into shock, which can lead to death.
Prevention
Currently, no treatment can prevent the development of esophageal varices in people with cirrhosis. While beta blocker drugs may be effective in preventing bleeding in many people who have esophageal varices, they don't prevent esophageal varices from forming. To keep your liver healthy and avoid complications of liver disease, it's important to avoid alcohol consumption and follow your healthcare provider's advice.
Home Remedies
If you are experiencing symptoms of esophageal varices or bleeding, it is important to seek medical attention immediately. Your healthcare provider will be able to recommend appropriate treatments and management strategies.
Treatment
Treatments for esophageal varices depend on whether the varices are bleeding or not. For bleeding esophageal varices, it is considered a medical emergency, and immediate treatment is necessary. Here are some treatments for esophageal varices:
- Endoscopic therapy: A healthcare professional may perform endoscopic therapy, such as band ligation or sclerotherapy, to treat bleeding varices. These treatments aim to stop the bleeding by obstructing or sealing the varicose veins.
- Medications: Beta blockers may be prescribed to reduce the risk of further bleeding. They help to decrease the blood flow to the varices.
- Transjugular intrahepatic portosystemic shunt (TIPS): In severe cases or when other treatments fail, a TIPS procedure may be performed. A small device is inserted into the liver through a catheter to create a shunt, which helps to lower the pressure in the portal vein.
- Balloon tamponade: In emergency situations, a balloon tamponade may be used to stop the bleeding. A balloon is inserted into the esophagus and inflated to compress the varices, thus stopping the bleeding. For non-bleeding esophageal varices, medical management with beta blockers may be recommended to prevent future bleeding episodes. Consult a healthcare professional for personalized advice and treatment options.