Esophageal varices are a chronic life-threatening condition where the veins lining the lower esophagus, (i.e. the food pipe connecting the mouth to the stomach) become abnormally large and swollen, a disorder which is often witnessed in people with chronic liver disease. Also Read: Liver Cancer: Causes, Symptoms And Treatment
Varices usually occur in people who are suffering from liver cirrhosis that can happen due to hepatitis, portal hypertension, large varices or chronic alcoholism. A blood clot or scarred tissue in the liver slows the flow of blood through the liver and forces the blood to back-up in the portal vein, which is the main hepatic vein that brings in blood from the gut to the liver. This "back up" causes high blood pressure in the portal vein and other nearby veins. This is called portal hypertension. To reach the interior of the liver, the blood often takes a different route i.e. through smaller blood vessels that are not meant to carry such large volumes of blood causing increased pressure on the blood vessels leading to leakage and rupture ultimately causing fatal complications.
Esophageal varices can also occur due to schistosomiasis which is a parasitic infection that can cause liver blockage thus increasing the pressure to back up in the portal vein. Varices often form in other parts of the body as well such as in the stomach causing gastric varices, duodenum causing duodenal varices, and rectum causing rectal varices. Also Read: Schistosomiasis: Causes, Symptoms And Treatment
The usual signs and symptoms of varices are only noticed once the blood vessels rupture:
- Hematemesis (bloody vomit)
- Stomach pain
- Bloody stools
- Black stools
- Multiple Organ Failure
The doctor may also suspect the risk of varices if one has liver damage, symptoms of which include:
- Jaundice (i.e. yellow colouration of skin and eyes)
- Ascites (i.e. fluid build-up in the abdomen)
- Easy bleeding or bruising
- Spider nevi (i.e. formation of tiny blood vessels under the surface resembling a spider web)
- Swollen spleen
- Palmar erythema (i.e. reddening of the skin of the palms)
- Hand deformity
Diagnosis And Treatment
If you are diagnosed with cirrhosis, your doctor may suggest you come for regular check-ups to reduce the risk and prevent varices. The doctor usually does a thorough physical check-up followed by a number of tests which include:
This endoscopic procedure analyses the size of the dilated veins and inspects any red spots to determine the risk of bleeding in the esophagus and the small intestine.
People who don’t prefer a routine endoscopic procedure are given a pill containing a miniature camera to take images of the liver and blood vessels to understand the extent of cirrhosis.
Ultrasounds, CT-scans and MRI-scans to examine the liver and blood circulation in the hepatic portal vein.
Treatment options mostly include lowering the blood pressure in the hepatic portal vein to reduce the risk of bleeding varices which includes:
Blood Pressure Lowering Medications:
The doctor may suggest medicines to lower the blood pressure and prevent back-flow in the hepatic portal vein.
Endoscopic Band Ligation:
The doctor may perform a surgical procedure called Endoscopic band ligation the doctor ties the bleeding veins using elastic bands.
Transjugular Intrahepatic Portosystemic Shunt (TIPS):
The doctor may also recommend a procedure called transjugular intrahepatic portosystemic shunt, where an opening is made between the portal vein and the hepatic vein, which carries blood from the liver to the heart. The procedure effectively reduces pressure in the hepatic portal vein and stops bleeding from esophageal varices.
Prescribing antibiotics to prevent the risk of infection and reoccurrence of bleeding.
Balloon Tamponade Procedure:
The doctor may apply pressure on the varices by inflating a balloon on it to temporarily stop the bleeding.
In case of severe liver cirrhosis or recurrence of esophageal varices, the doctor often performs a liver transplant.