Esophageal varices

Esophageal varices are diagnosed by upper gastrointestinal endoscopy.

Varicose veins are dilated veins in the esophagus or stomach. These veins are formed as a result of portal hypertension, which in turn is caused by liver cirrhosis.

Symptoms

Esophageal varices do not cause pain or discomfort, except when it bleeds. Variceal bleeding is a serious complication of chronic liver damage and can manifest in the following ways:

• Vomiting blood (hematemesis)

• Dark tarry feces , foul-smelling (“melena”)

• Fainting

• Chronic anemia in cases of bleeding in small quantities from portal hypertension gastropathy

Diagnosis

Esophageal or gastric varices are diagnosed by endoscopy. Both, size and some endoscopic signs of varices are useful at predicting risk  of bleeding.

Treatment

Endoscopic variceal ligation is a procedure to install rubber bands that obliterate the venous cords that arise in the esophagus.

When varicose veins are small and have never bled, require no specific treatment. In these cases, endoscopy should be repeated annualy.

If varicose veins are large and have not bled before, a preventive treatment is recommended (primary prophylaxis). Drugs such as beta-blockers (propranolol and nadolol) are used for this purpose.

In cases of active bleeding, the patient should present immediately to the emergency room. In addition to hospitalization and the contribution of volume (serum), no intravenous medications that help control bleeding, such as terlipressin, octreotide or somatostatin. However, the treatment of choice is endoscopic ligation of esophageal varices or cyanoacrylate injection in gastric varices.

If endoscopic measures are not effective in controlling bleeding installation of a TIPS is an option, which involves insertion of a prosthesis (stent) that connects the portal vein with the hepatic vein. It is installed via a catheter inserted into a neck vein. One of the risks of this procedure is the development of encephalopathy.

Once bleeding has occurred, the possibility of future recurrence is high, so a treatment is needed for avoiding this complication (secondary prophylaxis). The options at this stage include admission to a program of variceal ligation, with endoscopic treatment every 3 to 6 weeks to achieve eradication of varices. Usually this is achieved after 3 to 4 sessions. Another option is the use of beta-blockers such as propanolol.