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Esophageal Varices

Definition


Disease: Esophageal Varices Esophageal Varices
Category: Digestive diseases

Disease Definition:

Esophageal varices are the abnormally enlarged veins in the lower part of the esophagus, the tube that connects the throat and stomach. Cirrhosis or other serious liver diseases could cause esophageal varices, along with other complications.

 

When normal blood flow to the liver is blocked, blood backs up into smaller, more fragile blood vessels in the esophagus and sometimes in the stomach or rectum as well, causing vessels to swell. This is how esophageal varices develop. In some cases, these varices could rupture, which will end up causing a life-threatening condition.

 

In order to stop bleeding from esophageal varices, a number of drugs and medical procedures are available. In people diagnosed with esophageal varices, these same treatments can help prevent bleeding.
 

Work Group:


Symptoms, Causes

Symptoms:

Bleeding will develop in about one-third of people with esophageal varices. Ranging from mild to severe, the signs and symptoms of esophageal bleeding include:

 

  • Lightheadedness
  • Vomiting blood
  • Excessive thirst
  • In severe cases, shock
  • Black, tarry or bloody stools
  • Due to unusually low blood pressure, decreased urination

 

In case a person develops some signs and symptoms of liver disease, they should see a doctor. These symptoms include:

 

  • Fatigue
  • Weight loss
  • Weakness
  • Edema, swelling of the legs and feet from retained fluid
  • Ascites, the buildup of fluid in the abdominal cavity
  • Easy bruising, or small, red spider veins under the skin
  • Yellowing of the skin and dark, cola-colored urine
  • Mental confusion, including forgetfulness or trouble concentrating (encephalopathy)
  • Itching of the hands and feet, and eventually of the entire body.

 

HOW TO KNOW THAT IT’S AN EMERGENCY:

A person should call the local emergency number immediately in case they’ve been diagnosed with esophageal varices and experience bloody vomit or stools, because these may indicate that esophageal varices have ruptured; this is a life-threatening condition that requires immediate medical care.
 

Causes:

Usually, blood coming from the intestine, spleen and pancreas enters the liver through a large blood vessel called the portal vein. However, when circulation through the liver is blocked by scar tissue, the blood backs up, causing the pressure within the portal vein to increase, a condition called portal hypertension. This forces blood into smaller veins in the esophagus, stomach and sometimes rectum. These fragile, thin-walled veins are caused to balloon outward and sometimes to rupture and bleed because of the excess blood pressure. Once they occur, these varices may continue to grow larger.

 

THE LEADING CAUSE OF ESOPHAGEAL VARICES:

Usually esophageal varices develop as a complication of cirrhosis. This irreversible scarring of liver tissue usually results from hepatitis B or C infection or alcoholic liver disease. Primary biliary cirrhosis is another liver disorder that destroys the small ducts carrying bile, which can also lead to esophageal varices and cause scarring of liver tissue. In some cases, enlarged veins in the esophagus could be caused by chronic conditions other than cirrhosis, such as:

 

Sarcoidosis:

Starting in the lungs, this inflammatory disease can affect almost any organ in the body, including the liver, and in some rare cases, it could cause cirrhosis.

 

Severe congestive heart failure:

When the heart cannot pump enough blood to meet the body’s needs, this condition occurs. In this disease, blood backs up into the vein between the liver and the right side of the heart, which increases blood pressure in the portal vein.

 

Budd-Chiari syndrome:

In this rare condition, the veins that carry blood out of the liver are obstructed by blood clots.

 

Schistosomiasis:

Millions of people in the developing world, including parts of Africa, the Caribbean, South America, Southeast Asia and the Middle East are affected by this parasitic infection. This condition damages the liver, along with the lungs, bladder and intestines.

 

Blood clot (thrombosis):

Esophageal varices may be caused by a blood clot in the portal vein or in the splenic vein, which feeds into the portal vein.
 

Complications

Complications:

Bleeding is the most serious complication of esophageal varices. In case someone has had a bleeding episode, it means that they’re at great risk of another, especially immediately following the first episode.

 

In people with esophageal varices recurrent bleeding is common. When left without treatment, about 70% of them will bleed again within one year of the first episode of bleeding. With each episode, the likelihood of death increases. The risk of repeated bleeding will be increased in case:

 

  • The patient is older
  • Has liver failure
  • Has kidney failure
  • Drinks alcohol

 

Some of the other complications of bleeding esophageal varices are:

 

Infection:

A life-threatening complication of bleeding varices or of certain treatment to control them may be aspiration pneumonia, which occurs when someone inhales vomit or other chemicals into their lungs unintentionally.

 

Hypovolemic shock:

When the body loses at least one-fifth of its blood volume, this condition occurs. Weakness, sweating, anxiety, low blood pressure, mental confusion, a rapid pulse and possibly unconsciousness are some of its symptoms.

 

Encephalopathy:

A damaged liver is not very effective at removing toxins from the body, which is one of its key tasks. The brain may be damaged by this buildup of toxins, leading to changes in the patient’s mental state, behavior and personality (hepatic encephalopathy). Some of its signs are symptoms are:

 

  • Confusion
  • Forgetfulness
  • Mood changes
  • Delirium and coma in some severe cases.
     

Treatments:

Preventing bleeding is the main goal in treating esophageal varices. The patient will be prescribed beta blockers, which are high blood pressure drugs, in order to reduce pressure in the portal vein after the initial episode of bleeding has resolved. When people have severe side effects or don’t respond to beta blockers, other drugs may be used. In some cases, varices could be injected directly with a solution that causes them to shrink; another method is that before the valices have a chance to bleed, they may be tied with elastic bands.

 

HOW TO TREAT BLEEDING:

Immediate treatment is essential for bleeding varices because they are life-threatening. In order to stop bleeding, the patient will most likely undergo one of these procedures:

 

Endoscopic injection therapy:

This procedure involves injecting the bleeding varices with a solution that shrinks them. Even though bleeding is usually controlled after one or two treatments, however, complications can occur, such as perforation of the esophagus and scarring of the esophagus, which leads to dysphagia (trouble swallowing).

 

Medications:

Usually, a drug called octreotide is used in combination with endoscopic therapy in order to treat bleeding from esophageal varices. This drug works by reducing pressure in the varices. After a bleeding episode, this drug should be continued for five days.

 

Variceal ligation:

This procedure is the preferred treatment for bleeding esophageal varices, during which an endoscope is used in snaring the varices with an elastic band that essentially “strangles” the veins. This procedure is less likely to lead to episodes of repeat bleeding, and it causes fewer serious complications than do other treatments.

 

Shunt:

This procedure is called transjugular intrahepatic portosystemic shunt (TIPS), during which a small tube called a shunt is placed between the portal vein and the hepatic vein that carries blood from the liver back to the heart. The tube is kept open with a metal stent. Usually, the shunt can control bleeding from esophageal varices by providing an artificial path for blood through the liver. However, a number of serious complications could be caused by TIPS, such as liver failure and encephalopathy that could develop when toxins that would normally be filtered by the liver are passed through the shunt directly into the bloodstream. This procedure is used as a temporary measure in people awaiting a liver transplant or when other treatments have failed.

 

Balloon tamponade:

While waiting for a permanent procedure, a balloon tamponade is sometimes used to stop severe bleeding, during which a tube is inserted through the nose and into the stomach and then inflated. Bleeding could stop temporarily because of the pressure against the veins.

 

Liver transplant:

Liver transplant is an option for people with severe or recurrent bleeding of esophageal varices because no treatment is entirely successful at preventing repeat bleeding episodes and because treatments themselves pose significant risks. Liver transplantation is usually successful; however, the number of people awaiting transplants far outnumbers the available organs. Some medical centers may require that people with alcoholic liver disease abstain from alcohol for at least six months before they`re eligible for transplant surgery, or they may not perform the surgery at all.
 

Prognosis:

Not available

Expert's opinion

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