Esophageal varices – general information

Esophageal varices are swollen blood veins in the esophagus. The esophagus, or the gullet, is a tube-shaped organ, about 25-30 cm long, which connects the throat to the stomach. It consists of muscular tissue in a vertebrate pattern, and its main functionality is to transport swallowed food to the stomach.

Esophageal varices mostly appear as an effect of cirrhosis. When the liver is diseased, scar tissue that results forms a clot in the blood vessels transporting blood through the liver, which leads to an increase in the blood pressure in the blood vessels. At this moment, blood is forced back into the veins to find alternate routes to decrease the pressure.

The blood superficial blood vessels around the esophagus mucosa are the ones affected by the high blood pressure in the portal vein. Although these veins are about 1 mm in diameter, when exposed to the increased blood pressure, they dilate and form the esophageal varices.

The most eloquent symptoms of esophageal varices are the dilated blood vessels in the esophagus mucosa. This event leads to an obvious elevation of the mucosa above the surrounding tissue. This can be seen during an endoscopy and is considered to be a main element in establishing the esophageal varices diagnostic.

Esophageal varices are most dangerous when the blood vessels rupture and start bleeding. There is a 70% chance for a patient that has bled once to experience another bleeding episode. In some cases, the loss of blood due to bleeding esophageal varices is so great, that it can lead to a state of shock, which can lead to the patient's death.

There are various techniques of treatment for esophageal varices, divided in two major categories: treatment to prevent the bleeding and treatment to stop esophageal varices from bleeding. To prevent the bleeding of esophageal varices, the best treatment focuses on lowering the blood pressure in the portal vein. Therefore, a beta blocker is administered to help reducing the blood flow. In the case of severe esophageal varices bleeding risk, a different type of treatment may be used. This may involve an endoscopy, during which the blood veins are tied with a rubber band or injected with medication.

To stop esophageal varices from bleeding, the treatment methods include the use of a rubber band to tie the bleeding blood veins or the injection of the bleeding veins with a solution to help them shrink. These procedures are more dangerous, as the esophagus may be damaged or ruptured during the treatment.  In combination with endoscopic therapy, blood pressure lowering medication is administered. The most common medicine is octreotide and the treatment must be continued for about five days after an esophageal varices bleeding episode.

A transjugular intrahepatic portosystemic shunt (TIPS), which basically means offering blood an alternate flow route, is another method used. TIPS represents a small tube placed between the portal vein and the hepatic vein, but its use can cause serious complications, due to blood toxins passed directly into the bloodstream.  Another method of treatment used is a liver transplant, but this is only usable on patients with severe liver disease or repeated bleeding esophageal varices episodes. This method has a very high success rate, but the main drawback is the fact that the number of available organs is significantly lower than the number of patients needing a transplant.

If esophageal varices are liver disease manifestations, there are a few actions that may improve a patient's condition. Drinking alcohol is a habit that aggravates the state of an already diseased liver, so stopping drinking alcohol may prove helpful. Also a change in the diet is recommended. Patients are advised to eat a fruit and vegetable based diet, to avoid or reduce the amount of fat or fried foods.