What is Esophageal Varices?
Enlarged and abnormal veins which are developed in the esophagus are called as esophageal varices. Serious liver diseases are the major cause of esophageal varices. Esophageal varices are a fairly common medical condition. To be more exact, esophageal varices are a gastroenterological condition. Gastroenterologists are medical professionals which treat this medical condition.
Esophageal Varices are also known by another medical name which is Oesophageal Varices. We can define Esophageal Varices (EV) as sub-mucosal veins located in the lower third of esophagus which are extremely dilated. Esophageal Varices are most of the time the consequence of a medical condition involving the liver called portal hypertension. Portal hypertension leads to Cirrhosis which later on can lead to the development of esophageal varices. Patients who suffer from esophageal varices have a strong affinity towards bleeding. This medical condition is fairly easily diagnosed.
Causes of Esophageal Varices
In the normal circumstances, the blood from the spleen and the intestines is being delivered to the liver via a vein called the portal vein. However, people who suffer from excessive liver scarring, known in medicine as cirrhosis, have a restricted blood flow through their ill liver. Because of the existing cirrhosis of the liver, the blood that comes to the liver may become re-routed around the liver as well through small blood vessels found in the stomach and the esophagus. When some of the before mentioned small blood vessels may become swollen and large. If those swollen and large blood vessels are located in esophagus, they are called Esophageal Varices.
In the situation mentioned above, the spleen might also become enlarged. Varices are so common that they can occur anywhere in the gastrointestinal tract but they mostly appear in esophagus and stomach.
One of the causes of esophageal varices can also be the thrombosis of the splenic veins. That can cause Esophageal Varices without the pre-existing Portal Hypertension. A medical condition called Schistosomiasis may also lead to the development of esophageal varices .
Due to high blood pressure in the hepatic portal system (portal hypertension), and varices' wall thinning, the varices themselves may become ruptured. If Esophageal Varices become ruptured, they cause the internal bleeding within the upper GI tract which includes the esophagus.
Likewise, sometimes small superficial blood vessels can become enlarged within the lining of the GI and thus ooze blood. This is called Portal Hypertensive Gastropathy (if it occurs in the stomach) and Portal Hypertensive Colonopathy (if it occurs in the colon). These conditions also lead to the development of Esophageal Varices.
Symptoms of Esophageal Varices
Esophageal Varices most of the time are not life threatening and they do not cause symptoms. Ironically, esophageal varices cause symptoms all of the sudden when they start to bleed. Esophageal Varices that bleed are a medical urgency and their bleeding can be fatal. Even in the case that the bleeding from the varices is stopped, several other complications might occur. Those complications include kidney failure, sepsis, confusion, coma, liver failure and pneumonia.
The signs and symptoms of Esophageal Varices that might have your doctor suspect that you have this condition are:
- Vomiting blood is the primary symptom of esophageal varices.
- Vomiting and having excessive amounts of blood in your vomit
- Feeling lightheaded all the time
- Losing consciousness too often
- Black or tarry stool
- Rapid heart beats
Since liver disease is the main cause of developing Esophageal Varices and other GI Varices, your family physician might have you screened for esophageal varices if you show any of the following Liver Disease symptoms and signs:
- Ascites - Fluid Buildup Within your Abdomen
- Bruising Easily
- Bleeding Easily
- Jaundice - Yellow Skin and Yellow Eyes
Pathophysiology of Esophageal Varices
One of the primary complications of portal hypertension is esophageal varices. Portal hypertension is a result of distortion in hepatic vascular bed and this will lead to slow blockage of portal vein blood flow. All of this happens because of water & sodium retention. As a consequence, there is high amount of blood flow to the portal vein which further causes portal hypertension. When the Hepatic Venous Pressure Gradient or HVPD increases beyond 12mmHg then esophageal varices starts to become visible and bleed.
Also, between 5 to 15 percent of cirrhosis sufferers have esophageal varices in a year. Most of the patients of cirrhosis develop esophageal varices in their lifetime.
Tests to Diagnose Esophageal Varices
People visit medical doctors without suspecting they have Esophageal Varices and they come complaining about liver pain. The most common cause of a liver pain is Cirrhosis. If a medical doctor approves you have Cirrhosis, he/she will most likely screen you for Esophageal Varices.
There are three tests which are used for diagnosing esophageal varices. They are:
- Endoscopic Exam. Upper GI Endoscopy is the best test that is run to screen for esophageal varices. Your doctor will insert a thin endoscope through your mouth all the way to your esophagus and search there for EV.
- Doppler Ultrasound and Abdominal CT Scan. Abnormal findings of the portal vein of the upper GI tract seen on the Doppler Ultrasound or on an Abdominal CT scan may make doctors suspicious that you have esophageal varices.
- Capsule Endoscopy. This endoscopic method is performed on the patients with a strong gag reflex. In this medical test, you swallow a small pill that contains camera on it and isn't soluble. The pill you have swallowed literally takes pictures of the inside of your stomach and esophagus. Thus it searches for esophageal varices.
Treatment for Esophageal Varices
In case you are diagnosed with esophageal varices , but they do not show any signs they will start bleeding soon, you will most certainly be admitted to a treatment that would prevent the bleeding of your esophageal varices.
The treatment that prevents Esophageal Varices from rupturing is the intake of beta blockers which decrease the blood flow in the portal vein.
Also, your gastroenterologists may recommend you to have your Esophageal Varices tied off to prevent bleeding in a procedure called band ligation. This surgery is performed with the help of an endoscope.
In case you start to bleed from your esophageal varices, you would either immediately be given a medication called Sandsostatin which decreases the blood flow from internal organs to the portal vein. Also, you may immediately be admitted to a medical procedure called TIPS (called transjugular intrahepatic portosystemic shunt). This shunt is put near your portal vein and it reduces the blood flow in it and thus prevents further life-threatening esophageal varices bleeding.
Diet for Esophageal Varices
If you or your loved one has esophageal varices, you are probably familiar with the fact that there is a special diet regime for esophageal varices. Certain foods have to be avoided by the persons with Esophageal Varices since they may cause the rupture of esophageal varices. Those foods include any foods that are hard for swallowing and chewing.
You should also avoid foods that cause constipation if you have been diagnosed with esophageal varices .
Prevention of Esophageal Varices
As we all know, Esophageal Varices develop from the pre-existing liver disease. The only way to prevent them from developing inside your esophagus is to start the treatment of any liver disease on time.
Risk Factors for Esophageal Varices
The main risk factor for developing Esophageal Varices is the pre existing Liver Disease, particularly Portal Hypertension. Almost everyone who has Portal Hypertension will develop EV at some point in life. However, most of the people with Portal Hypertension will develop Esophageal Varices that will not bleed. Varices that do not bleed do not have to be treated and they are not life threatening.
However, there are certain risk factors that may cause the pre-existing Esophageal Varices to bleed. Those risk factors include:
- Large Varices. The larger the varices, the higher the chance that they will fall apart and cause internal bleeding which may be fatal.
- High Portal Vein Pressure. The amount of pressure in the portal vein is directly related to the risk of Esophageal Varices bleeding. The higher the pressure in the portal vein, thus the higher the chance of esophageal varices rupture.
- Severe Cirrhosis. The more serious the case of a liver disease is, the higher the chance that the pre-existing esophageal varices which are a result of the liver disease will bleed.
- Excessive Alcohol Intake. Persons with esophageal varices should avoid at all costs drinking alcohol since it often times leads to the rupture of esophageal varices.