Esophageal Varices: Causes, Symptoms, Diagnosis, Treatment, and Prevention
Generally, esophageal varices are swollen veins in the lining of the esophagus, the tube that connects the mouth and stomach. Usually, portal hypertension is caused by liver disease, such as cirrhosis, scarring of the liver. They are a serious complication of portal hypertension, high blood pressure in the vein carrying blood to the liver. It is possible for esophageal varicose veins to bleed easily and can cause life-threatening internal bleeding.
Causes of Esophageal Varices
The main cause of esophageal varices is portal hypertension, which can result from various liver diseases, such as:
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Hepatitis infection, which is inflammation of the liver caused by viruses or other factors.
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Alcoholic liver disease, which is damage to the liver caused by excessive alcohol consumption.
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Fatty liver disease, which is accumulation of fat in the liver cells due to obesity, diabetes, or other metabolic disorders.
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Primary biliary cholangitis, which is a rare autoimmune disease that affects the bile ducts in the liver.
A portal hypertension occurs when the normal flow of blood to the liver is blocked by scar tissue, inflammation, or a blood clot, forcing the blood to find alternative routes through smaller veins, such as those in the esophagus. These veins are unable to handle high pressures or volumes of blood, so they become enlarged and fragile. When irritated by food, alcohol, or vomiting, they can rupture and bleed.
Symptoms of Esophageal Varices
Esophageal varices usually do not cause any symptoms until they bleed. Bleeding esophageal varices are a medical emergency and can cause:
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Vomiting large amounts of blood or material that looks like coffee grounds.
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Black, tarry, or bloody stools.
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Lightheadedness, dizziness, or fainting due to blood loss.
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Low blood pressure and shock.
Other symptoms that may indicate liver disease or portal hypertension include:
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Yellowing of the skin and eyes, known as jaundice.
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Easy bruising or bleeding.
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Swelling of the abdomen, legs, or ankles, due to fluid buildup.
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Itching of the skin.
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Confusion, memory loss, or changes in mental state, due to toxins affecting the brain.
Diagnosis of Esophageal Varices
You will be asked about your medical history, symptoms, and risk factors for liver disease in order to diagnose esophageal varicose veins. Additionally, your doctor will perform a physical examination and order blood tests to assess the function of your liver and blood count. One or more of the following tests may be performed by your doctor to confirm the presence and size of esophageal varicose veins:
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Your doctor will be able to see your varicose veins and assess their risk of bleeding with upper endoscopy, which involves inserting a thin, flexible tube with a camera and a light through your mouth and into your esophagus. A biopsy can also be performed, or treatment can be given to stop or prevent bleeding.
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A esophageal capsule endoscopy involves swallowing a capsule with a camera attached to it and taking pictures of your esophagus as it passes. You can use this test if your varicose veins are located in the upper part of your esophagus or if you cannot tolerate an upper endoscopy.
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A CT scan or an MRI can be used to determine the size and shape of the liver and spleen, as well as the blood flow in the portal vein and other vessels. These tests can help determine the cause and severity of portal hypertension and esophageal varicose veins in the esophagus.
Treatment of Esophageal Varices
A variety of treatments are available for esophageal varicose veins, depending on whether they bleed or not. The main goals of treatment are to stop or prevent bleeding, reduce portal hypertension, and manage liver disease.
Treatment for bleeding esophageal varices
You may need fluids, blood transfusions, and medications to stabilize your blood pressure and stop the bleeding. You may also need one or more of the following procedures to control the bleeding:
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Endoscopic band ligation, which is a procedure that involves using an endoscope to place rubber bands around the varices to cut off their blood supply and make them shrink.
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Endoscopic sclerotherapy, which is a procedure that involves using an endoscope to inject a chemical solution into the varices to harden and seal them.
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The balloon tamponade procedure involves inserting a balloon-tipped tube through your nose and into your esophagus. This is a temporary measure that can lead to serious complications, including infection, ulcer, and perforation of the esophagus. The balloon is inflated to compress the varicose veins and stop the bleeding.
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The transjugular intrahepatic portosystemic shunt (TIPS) creates a new blood flow pathway between the portal vein and the hepatic vein, which drains blood from the liver. A TIPS is inserted through a vein in your neck and guided to your liver through an X-ray. A metal stent is placed to keep the shunt open. This reduces the pressure in your portal vein and varicose veins. While this procedure can improve your symptoms, it can also cause side effects such as infection, bleeding, or liver failure.
Treatment to prevent bleeding esophageal varices
If you have esophageal varices that are not bleeding, but are at high risk of bleeding, your doctor may recommend one or more of the following treatments to prevent bleeding:
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Medications, such as beta blockers or nitrates, which can lower the blood pressure in the portal vein and the varices, and reduce the risk of bleeding.
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Endoscopic band ligation, which can be repeated every few weeks until the varices are eliminated or reduced in size.
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TIPS, which can be considered if medications and endoscopic band ligation are not effective or well-tolerated.
Treatment for liver disease and portal hypertension
To treat the underlying cause of esophageal varices, you may need to manage your liver disease and portal hypertension. This may involve:
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Avoiding alcohol and other substances that can damage your liver, such as certain medications, herbal supplements, or drugs.
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Eating a healthy diet that is low in salt and fat, and high in fruits, vegetables, and lean protein. This can help prevent fluid buildup, malnutrition, and weight loss.
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Taking medications to treat your liver condition, such as antiviral drugs for hepatitis, corticosteroids for autoimmune hepatitis, or ursodeoxycholic acid for primary biliary cholangitis.
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When you have end-stage liver disease and have life-threatening complications, such as bleeding esophageal varicose veins, you may need a liver transplant, which involves replacing your damaged liver with a healthy one from a donor.
Prevention of Esophageal Varices
To prevent esophageal varices, you need to prevent or treat liver disease and portal hypertension. This may involve:
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Getting vaccinated against hepatitis A and B, which are viral infections that can cause liver inflammation and damage.
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Practicing safe sex and avoiding sharing needles, which can prevent hepatitis C and HIV, which are viral infections that can also cause liver disease.
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Limiting or avoiding alcohol consumption, which can harm your liver and increase your risk of cirrhosis and portal hypertension.
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Maintaining a healthy weight and managing your blood sugar, cholesterol, and blood pressure, which can prevent fatty liver disease and other metabolic disorders that can affect your liver.
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Getting regular check-ups and screening tests for liver disease, especially if you have risk factors, such as family history, chronic viral infection, or heavy alcohol use.
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Seeking medical help if you have symptoms of liver disease or portal hypertension, such as jaundice, swelling, bleeding, or confusion.
As a result of liver disease and portal hypertension, esophageal varicose veins can cause life-threatening bleeding which requires immediate medical attention. Preventing or treating esophageal varicose veins requires preventing or treating liver disease and portal hypertension. It is possible to reduce your risk of esophageal varicose veins and improve your quality of life by taking care of your liver and overall health.
