Esophagogastric varices

Esophagogastric varices are dilated submucosal veins in the esophagus and stomach, which can become abnormally enlarged. Often associated with liver cirrhosis, portal hypertension, or other conditions that cause increased pressure in the portal vein system, esophagogastric varices are a significant source of gastrointestinal bleeding and can lead to life-threatening hemorrhage.

Causes

Esophagogastric varices primarily develop due to increased pressure in the portal venous system. This increased pressure, known as portal hypertension, is most commonly a result of liver cirrhosis. Cirrhosis leads to obstruction of blood flow through the liver, causing blood to back up into the portal vein system. Other causes may include blood clots in the portal vein (portal vein thrombosis), congenital portal vein abnormalities, and schistosomiasis.

Symptoms

The most feared complication of esophagogastric varices is bleeding, which can be life-threatening. Symptoms of bleeding varices include vomiting blood (hematemesis), passing black, tarry stools (melena), and anemia. In severe cases, it can lead to shock due to significant blood loss.

Diagnosis

Diagnosis of esophagogastric varices is often made through endoscopy, where a flexible tube with a camera (endoscope) is inserted through the mouth to visualize the esophagus, stomach, and the beginning of the small intestine. Other diagnostic tools include imaging studies such as ultrasound, CT scan, and MRI to evaluate the liver, spleen, and portal venous system.

Treatment

Treatment for esophagogastric varices includes both acute management of bleeding and prevention of future bleeding episodes. Acute bleeding can be managed through endoscopic therapies such as band ligation or sclerotherapy, where varices are either tied off or injected with a solution that causes them to shrink. Medications, including beta-blockers, can be used to lower portal blood pressure and reduce the risk of future bleeding. In severe cases, a TIPS procedure (transjugular intrahepatic portosystemic shunt) may be performed to reduce portal pressure by creating a pathway for blood flow between the portal and systemic venous systems.

Prevention

Preventive measures for esophagogastric varices focus on managing the underlying cause of portal hypertension. This may include treatment for liver cirrhosis, avoiding alcohol, and managing chronic hepatitis. Regular screening endoscopies are recommended for individuals with known risk factors to detect varices early and initiate preventive treatment.