ESOPHAGEAL VARICES

SYMPTOMS

Esophageal varices may not cause symptoms until they rupture and bleed, which can lead to life-threatening complications. Symptoms of bleeding esophageal varices may include:

• Vomiting blood (hematemesis), which may be bright red or resemble coffee grounds.
• Black, tarry stools (melena) due to digested blood passing through the gastrointestinal tract.
• Weakness, lightheadedness, or fainting due to blood loss (hypovolemic shock).
• Abdominal pain or discomfort.
• Difficulty swallowing (dysphagia) if the varices are large enough to compress the esophagus

DIAGNOSIS

Diagnosing esophageal varices typically involves a combination of clinical evaluation and imaging studies. Diagnostic steps may include:

• Upper endoscopy: Direct visualization of the esophagus using a flexible tube with a camera (endoscope) allows for the detection of esophageal varices and assessment of their size, location, and risk of bleeding.
• Imaging studies: Imaging modalities such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to evaluate liver function, assess portal hypertension, and identify underlying liver disease.
• Liver function tests: Blood tests may be performed to assess liver function, measure levels of liver enzymes, and evaluate for evidence of liver disease or dysfunction.

TREATMENT

Treatment of esophageal varices aims to prevent bleeding, manage complications, and reduce the risk of recurrence. Treatment options may include:

• Medications: Beta-blockers such as propranolol or nadolol may be prescribed to reduce portal pressure and lower the risk of bleeding in individuals with esophageal varices.
• Endoscopic therapy: Endoscopic procedures, such as variceal band ligation or sclerotherapy, may be performed to treat or prevent bleeding from esophageal varices by sealing off the enlarged veins or inducing their shrinkage.
• Transjugular intrahepatic portosystemic shunt (TIPS): In select cases, a TIPS procedure may be performed to create a shunt within the liver to redirect blood flow and reduce portal pressure, thereby lowering the risk of variceal bleeding.
• Liver transplantation: For individuals with advanced liver disease and recurrent variceal bleeding, liver transplantation may be considered as a definitive treatment option to address the underlying cause of portal hypertension.