Esophageal varices are enlarged or swollen veins located at the lower part of the esophagus. The esophagus is a hollow tube that transports food from your mouth to your stomach. Varices normally occur as a result of problems with blood flow in the liver caused by chronic liver disease. Usually, a blood vessel known as the portal vein carries blood from the digestive organs to the liver. But with liver disease, blood flow can be blocked as a result of scarring of the liver. This increases the blood pressure in the portal vein. Blood then backs up in surrounding veins in the esophagus and stomach, causing varices. Varices are a severe and deadly problem. Treatment is needed to stop them from bursting (rupturing) and bleeding. If bleeding occurs, it can be fatal.
Symptoms of esophageal varices
Symptoms do not occur unless the varices are bleeding. This is an emergency problem. If you experience any of the following symptoms, get medical attention immediately:
- Vomiting blood.
- Black or bloody stools.
- Feeling lightheaded or fainting.
You’ll likely be checked for varices if you have liver disease or other health issues that can cause them. Your doctor will ask about your signs/symptoms and health history. You’ll also be examined. Tests are then carried out to confirm the problem. Tests can include:
- Upper endoscopy: This is carried out to see inside the upper digestive tract. During the test, an endoscope is used. This is a thin, flexible tube with a small camera on the end. It’s inserted through your mouth. It’s then guided down through your esophagus, stomach, and first section of your small intestine. This allows the doctor to check for varices and find any bleeding.
- Imaging tests: These provide pictures of the liver or blood flow in the liver. They allow the doctor to check for enlarged or swollen veins around the liver and assess the risk of bleeding. Common imaging tests carried out include ultrasound and CT scans.
Treating esophageal varices
The aim of the treatment is to reduce the risk of bleeding or to control bleeding. Treatment can include the following:
- Medicines: These may be prescribed to lower the blood pressure inside the swollen veins. This reduces the risk of bleeding. Beta-blockers are the most common medicine used.
- Endoscopic therapy: These are treatments for swollen or bleeding veins that are carried out using an endoscope. With ligation, small rubber bands are placed around the veins to close them off and stop any bleeding. With sclerotherapy, a blood-clotting medicine is injected into the veins to cause scarring and shrink them.
- Balloon tamponade: A tube with a balloon is guided down into your esophagus and stomach. The balloon is then filled with air. This puts pressure on swollen or bleeding veins to control bleeding. This is a temporary way to control bleeding till other treatments are available.
- Surgery: This may be carried out to place a tube-like device (known as stent) in the liver. The stent helps to redirect blood flow in the liver to lower the blood pressure in swollen veins. Sometimes, the swollen veins may be connected to nearby veins to redirect blood flow. In severe cases, a liver transplant may be needed. For this surgery, a diseased liver is replaced with a healthy liver from another person.
Regular visits with your doctor are needed to check for bleeding of the varices. If bleeding occurs, it is likely to occur again. More treatments will then be needed in the future. Once endoscopic therapy (banding) is done, regular follow-up endoscopic scans with banding are performed to get rid of the varices completely. If you are given medicines to take by mouth, be sure to take them as instructed. Work closely with your doctor to manage your condition.
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