Esophageal Varices

Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus.

People with liver diseases such liver cirrhosis and people with portal hypertension are at a higher risk of getting this disorder.

They develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding.

A number of drugs and medical procedures can help prevent and stop bleeding from esophageal varices.

Esophageal varices rarely cause symptoms unless they rapture. This is more so especially in people with chronic liver diseases.

However,when symptoms are experienced they may include: vomiting wih or without blood, lightheadedness, black stools (melena), paleness and symptoms of chronic liver failure.

The signs of chronic liver failure include: yellow discoloration of the skin and eyes,swollen spleen and accumulation of fluid in the abdominal cavity (ascites).

Esophageal varices are caused when there is impaired blood flow to the liver mostly due to formation of scar tissue in the liver.

This can occur in liver cirrhosis, hepatitis infection and fatty liver disease.

Other causes are formation of blood clots in the vessels that lead to the portal vein, arasitic infections such as Schistosomiasis (found in parts of Africa, Asia, Middle East and the Caribbean. Budd-Chiari Syndrome, a rare condition, causes blood clots that can blood the veins that carry blood from the liver.

Esophageal varices are diagnosed by endoscopy.

This is a test in which a tube that has a camera at one end is inserted into the esophagus through the mouth. Images are usually seen on a screen.

Samples of the tissue in the esophagus (biopsy) can also be taken for further laboratory studies.

Exmination of stools is also done to check for presence of blood in the stools.

For patients who have already been diagnosed with esophageal varices, treatment is aimed at reducing the chances of bleeding.

This can achieved by giving bete-blockers such as propranolol and nitrates.

If tratement with these is containdicated then ligation of varices is performed.

The primary goal in the treatment of esophageal varices is to prevent bleeding.

Treatments that help to prevent bleeding include: using medications such as beta blockers which help reduce portal vein pressure and thus reduce chances of bleeding, tying bleeding veins with elastic bands. In this procedure,the doctor snares the varices and wraps them with an elastic band with the help of an endoscope.

Other methods that can be used include: diverting blood away from the portal vein or replacing the patient's diseased liver with a healthy one.

The possible complications of esophageal varices include:

• Encephalopathy (sometimes called hepatic encephalopathy)
• Esophageal stricture after surgery or endoscopic therapy
• Hypovolemic shock
• Infection such as pneumonia
• Bloodstream infection
• Peritonitis
• Recurrence of bleeding after treatment

Bleeding is most likely to occur if the patient has high portal vein pressure, very large varices,red marks on the varices, severe liver cirrhosis and excessive alcohol intake.

In some cases, blood loss can be so severe that it leads to death.