Esophageal Varices

Esophageal Varices– Dilated blood vessels in the esophagus.

Causes and Incidence

The cause of esophageal varices is portal hypertension in association with cirrhosis, liver parenchymal disease, duodenal ulcer, or acute pancreatitis. About 50% of individuals with cirrhosis eventually develop bleeding esophageal varices.

Disease Process

Portal veins narrow and become obstructed as a result of the underlying disease process. As the lumen narrows, the venous blood returning to the right atrium from the intestine and spleen seeks new routes through collateral vessels. These collateral vessels enlarge and become tortuous, and the mucosa ulcerates.

Symptoms

Hematemesis and melena are common. However, bleeding may occur abruptly, with massive hemorrhage accompanied by blood coming out of the mouth.

Potential Complications

Esophageal rupture, with massive hemorrhage and death, is the most common complication. With acute bleeding, the mortality rate is about 50%. Approximately 60% of individuals die within a year of the first episode of bleeding.

Diagnostic Tests

History of underlying disease, plus hematemesis or melena. Hemorrhage with varices is confirmed by an upper gastrointestinal series, and bleeding site is confirmed by endoscopy or mesenteric angiography.

Treatments

Surgery
Portacaval, splenorenal, or mesocaval shunt to relieve portal pressure; ligation of bleeders.

Drugs
Vasopressin or beta-blocker to lower portal hypertension; antacids or histamine receptor antagonists to inhibit gastric acid; vitamin K; antibacterial agents.

General
Control of acute bleeding through ice water lavage and esophageal tamponade techniques; blood transfusions, fluid replacement; sclerotherapy to thrombose varices.