In medicine (gastroenterology), esophageal varices are extreme dilations of sub-mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily.

Patients with esophageal varices have a strong tendency to develop bleeding.

Esophageal varices are diagnosed with endoscopy.

Pathogenesis

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The lower esophagus is a site of 'portosystemic anastamosis', meaning that venous blood flow in the portal circulation (i.e. draining into the portal vein) and the mesenteric circulation freely mix.

In situations where portal pressures increase, which are typically related to cirrhosis, there is dilation of veins in the anastamosis, leading to esophageal varices.

Varices can also form in other areas of the body, including the stomach (gastric varices), duodenum (duodenal varices), and rectum (rectal varices). Treatment of these types of varices may differ.

Treatment and the role of endoscopy

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In emergency situations, the care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics (as infection is either concomittant, or a precipitant).

Therapeutic endoscopy is considered the mainstay of urgent treatment. Two main therapeutic approaches exist:

• Variceal ligation, or banding
• sclerotherapy

In cases of refractory bleeding, balloon tamponade may be necessary, usually as a bridge to further endoscopy, a transjugular intrahepatic portosystemic shunt (TIPS), or a distal splenorenal shunt procedure or a liver transplantation.

Prevention

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Ideally, patients with known varices should receive treatment to reduce their risk of bleeding (Lebrec et al., 1981). The non-selective β-blockers (e.g., propranolol, timolol or nadolol) and nitrates have been evaluated for secondary prophylaxis. The effectiveness of this treatment has been shown by a number of different studies (Talwalkar JA & Kamath PS, 2004).

Unfortunately, non-selective β-blockers do not prevent the formation of esophageal varices (Groszmann RJ et al., 2005).

References

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See also

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• gastric varices
• intestinal varices

Other causes of GI bleeding include:

• esophagitis
• Mallory-Weiss syndrome
• peptic ulcer

Gastroenterology

Ösophagusvarizen