About Esophageal Varices
Esophageal varices are caused by high blood pressure in the portal vein, a condition known as portal hypertension. The most common cause of portal hypertension is cirrhosis, which is severe scarring of the liver resulting from excessive alcohol consumption or serious infections like hepatitis. Other causes include portal vein thrombosis, where blood clots form inside the portal vein, and idiopathic portal hypertension, where the cause is unknown.
Non-modifiable risk factors for esophageal varices cannot be changed or controlled. These include:
- Liver disease: Any form of liver disease can increase the risk, but cirrhosis is the most common cause.
- Age: Older age is associated with a higher risk.
Modifiable risk factors for esophageal varices can be influenced or changed. These include:
- Alcohol consumption: Excessive alcohol intake can lead to liver damage and increase the risk of varices.
- Obesity: Being overweight or obese can contribute to liver disease and therefore increase the risk.
- Hepatitis infection: Infections like hepatitis B or C can cause liver damage and raise the risk.
It's important to note that these risk factors can vary in their impact on individuals, and it's always advisable to consult with a healthcare professional for personalized advice.
Esophageal varices may not have obvious symptoms in the early stages, but as they progress or become more severe, the following symptoms may occur:
Early Symptoms:
- Unusually pale skin
- Ongoing tiredness
- Shortness of breath
- Faintness or dizziness
Later Stage or Higher Severity Symptoms:
- Black or tarry stools
- Dark or bright red blood in stool
- Bright red blood in vomit
- Severe bleeding can cause symptoms such as stomach pain, light-headedness or fainting, rectal bleeding, and bloody stools.
It's important to note that esophageal varices often don't cause symptoms until they rupture and bleed. If you experience any of these symptoms, especially severe bleeding, it's crucial to seek immediate medical attention. Remember to consult with your healthcare professional for an accurate diagnosis and appropriate management.
To diagnose esophageal varices, healthcare providers commonly perform the following examinations, tests, and procedures:
- Physical examination: When healthcare providers are doing a physical exam to diagnose esophageal varices, they typically can’t directly see or feel the varices, so they look for signs of liver disease and portal hypertension. Signs may include jaundice (yellowing of the skin), buildup of fluid in the abdomen (ascites), enlarged spleen, or unexplained bruising or bleeding.
- Blood tests: These tests evaluate blood cell counts and assess liver and kidney function.
- Endoscopy: A small camera scope is inserted into the mouth to examine the esophagus, stomach, and beginning of the small intestine. This procedure allows for a closer look at dilated veins and organs. Tissue samples can also be taken, and bleeding can be treated during this procedure.
- Imaging tests: CT and MRI scans are used to examine the liver and abdominal organs, as well as evaluate blood flow in and around these organs.
To determine the stage or severity of esophageal varices, additional examinations, tests, and procedures may be recommended:
- Electronic radial-arrayed EUS: This procedure uses ultrasound technology to observe branching veins, including blood flow direction.
- Ultrasonic Mini Probe (UMP) Endoscopy Technique: This technique looks at the whole area around blood vessels outside the esophagus. It uses a special scope with an automatic water supply or fills the esophagus with water that has no air in it for a clearer view.
It's important to consult with your healthcare provider about which specific examinations, tests, and procedures are appropriate for your individual situation.
The goals of treatment for esophageal varices are to prevent ruptures and bleeding and reduce pressure in the veins. The following treatments work by controlling blood pressure, shrinking swollen veins, and redirecting blood flow to reduce pressure in the portal vein:
- Control portal hypertension: This is the primary step in reducing the risk of bleeding. Medications called beta-blockers, such as propranolol, are prescribed to lower blood pressure and decrease the force of the heart's contractions.
- Endoscopic sclerotherapy: Using an endoscope, a doctor injects a medication into the swollen veins to shrink them. This helps prevent bleeding.
- Endoscopic variceal banding: With the help of an endoscope, a rubber band is placed around the varices in the esophagus to prevent them from bleeding. The bands are usually removed after a few days.
- Transjugular intrahepatic portosystemic shunt (TIPS) procedure: This involves creating a new channel for blood flow between the portal vein and hepatic vein using X-ray guidance. By reducing pressure in the portal vein, it helps lower the risk of bleeding.
- Distal splenorenal shunt procedure: In this procedure, a connection is made between the splenic vein and left renal vein to divert blood flow away from the varices, reducing pressure and preventing bleeding.
- Health behavior changes, such as reducing alcohol consumption and treating underlying liver conditions, can also help prevent esophageal varices.
Remember to consult your healthcare professional for personalized advice. Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.