The esophagus is the tube that connects the mouth to the stomach. Esophageal varicies are abnormally engorged veins within the esophagus. They are most commonly seen in people with liver disease. Often, the person will have no symptoms to suggest they have esophageal varices, but various complications can result and can be life-threatening. For this reason, people with esophageal varices generally require medication or surgical procedures.
When a person has liver disease, blood flow to the liver can become restricted. This usually happens because clots have formed in the blood vessels or because scarring in the liver causes a blockage. The body then has to find a way to bypass the blockages to maintain normal blood flow. It does this by diverting blood into smaller vessels not designed to cope with so much blood. The vessels become enlarged and potentially rupture.
Unless the varices have ruptured, the person is unlikely to have any symptoms. Once a rupture occurs, there will usually be signs that the esophageal varices are bleeding. The person may vomit blood or see evidence of blood in stools, which will look black and tar-like. If the bleeding is severe, he or she may feel unwell or even fall unconscious. Even if the person has no symptoms, a doctor may suspect esophageal varices if the patient has, or is suspected to have, liver disease.
Esophageal varices can develop when cirrhosis (scarring) of the liver interrupts circulation. A thrombosis or blood clot in the vessels supplying the liver can also lead to esophageal varices. Schistosomiasis, a parasitic infection, causes damage to various bodily organs including the liver. This damage can interrupt blood flow and cause esophageal varices, as well.
If too much pressure builds up within the vessels of the esophagus, they can rupture and bleed. The severity of this bleeding varies; in the worst cases, ruptured esophageal varices can lead to significant blood loss, which can cause the person to go into shock. Without prompt treatment, this can be fatal. People who have experienced this complication are far more likely to have subsequent episodes.
People with liver disease are more likely to have ruptured esophageal varices if they have increased blood pressure in the vessels supplying the liver. Large varices are more likely to rupture than small ones. People are also more likely to have a rupture if their liver disease is very advanced. Continuing to drink alcohol once diagnosed with esophageal varices increases the risk of bleeding, and this risk rises even higher if alcohol consumption caused liver disease in the first place.
People with liver disease are often routinely screened for esophageal varices. This is often done using an endoscopy. During this procedure, a thin catheter containing a camera is passed down the throat into the esophagus, enabling the doctor to see any esophageal varices, how large they have become, and signs that they are likely to rupture. Sometimes, doctors will perform a capsule endoscopy, which requires the patient o swallow a tablet-sized camera. CT and ultrasound scans are also sometimes used to diagnose esophageal varices.
Most people with esophageal varices will be offered treatment to prevent ruptures and other complications. The doctor may prescribe a medicine called beta blockers that can help reduce blood pressure in the vessels of the liver. If it looks like the varices are likely to rupture, the physician may recommend a procedure called esophageal band ligation. This involves using bands to tie off the varices so blood can no longer flow through them.
Esophageal band ligation can staunch the flow of blood in ruptured varicies, as well, but in extreme cases, the patient may require a liver transplant. If the person has lost a lot of blood, a blood transfusion can restore normal blood volume. The doctor may also recommend a shunt to help reduce pressure in the portal vein. However, because this can cause serious side effects, this treatment is recommended only when all other possible routes have failed.
If a person knows they have liver disease or esophageal varices, he or she should be vigilant in checking for signs of possible bleeding. The doctor will most likely discuss risks and the need to seek quick treatment. Ruptured esophageal varices are potentially life-threatening medical emergencies. If the person notices any symptoms of bleeding varices, an immediate visit to the emergency room is essential.
Once liver disease develops, little that can be done to prevent esophageal varices. However, some steps can help prevent liver disease from occurring in the first place or becoming more severe. As excessive alcohol consumption is a leading cause of liver disease, limiting or eliminating alcohol use can lower risk. Maintaining a balanced diet and a healthy body weight can also help, as excess body fat can cause damage to the liver.
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