Esophageal varices are abnormal, enlarged veins present in the lower part of the esophageal tube which connects the throat to the stomach. This medical condition mostly occurs in people who are affected with serious liver diseases. They usually develop when there is a blockage in the normal blood flow to the liver. This blockage is caused due to a clot or scar tissue in the liver. Varices can turn out to be quite life-threatening if they rupture and bleed. So, you need to know more about these swollen veins on the esophagus lining and its complications.
What are Esophageal Varices:
The esophagus is the tube which connects your throat to your stomach. Esophageal varices are the enlarged veins (varices) on the lining of the esophagus. They occur due to certain blockages like clots and scars. To go around such blockages, blood starts flowing into smaller blood vessels that are not originally meant for carrying large volumes of blood. These veins then swell up, dilate due to the increased blood flow and are known as varices. This ultimately causes the vessels to rupture and leak blood, known as bleeding esophageal varices. This condition can be set straight with the help of certain medicines and medical procedures.
Symptoms of Esophageal Varices:
Esophageal varices do not usually cause any signs or symptoms, until they start bleeding. When this happens, you may experience:
- Vomiting too much of blood i.e. hematemesis
- Black, tarry and bloody stools
- Light-headedness or unconsciousness
- Stomach pain
- Extremely low blood pressure
- Pale, clammy skin
- Irregular breathing
Causes of Esophageal Varices:
The liver is the largest gland and the largest solid organ in the human body. It performs more than 500 essential tasks. Classified as part of the digestive system, the roles of the liver include protein synthesis, detoxification as well as the production of chemicals that help digest food.
The portal vein delivers blood into the liver from several other organs in the gastrointestinal tract. Esophageal varices are mainly a result of high blood pressure in the portal vein known as portal hypertension. This pushes the built-up blood into the surrounding vessels, dilating and swelling up the esophageal veins. Causes of portal hypertension and consequently esophageal varices are:
- Liver cirrhosis: Severe liver scarring or cirrhosis is the most common cause of portal hypertension. This develops because of excessive alcohol consumption, infections like hepatitis, fatty liver disease, bile duct disorders etc.
- Thrombosis: A blood clot formation in the portal vein or in any of the veins which feed into portal vein[ like splenic vein] leads to esophageal varices.
- Parasitic infections: A parasitic infection known as schistosomiasis is found in certain parts of Africa, the Caribbean, East Asia, South America and the Middle East. This parasite damages the liver along with your lungs, bladder & intestine.
- Budd-Chiari syndrome: This is a syndrome which involves the blockage of certain veins in the liver.
Risk factors include:
Even though many people develop esophageal varices, most of them may not have bleeding. These varices are most likely to bleed due to:
- High portal vein pressure
- Large varices
- Severe cirrhosis or liver failure
- Excessive alcohol intake
- Bacterial infections
- Excessive vomiting and constipation
- Personal history of bleeding esophageal varices
Treatment for Esophageal Varices:
Treatment of esophageal varices is aimed at preventing liver damage, stopping the varices from bleeding and controlling the blood loss if it happens. Bleeding esophageal varices are fatal. Treatment is available to both prevent and stop the bleeding.
- Treatment to prevent bleeding: Treatments which lower the blood pressure in the portal vein helps to reduce the risk of bleeding. These are:
- Medications: Blood pressure drugs like beta blockers help to reduce the blood pressure in the portal vein. These medicines like Inderal, Corgard etc. help to reduce the chances of bleeding.
- Elastic Bands: If you are at a risk of bleeding esophageal varices or have experienced a previous episode of bleeding, your doctor may suggest a procedure known as endoscopic band litigation. Elastic bands are used to tie or ‘strangle’ veins so that they are unable to bleed.
- Treatment for bleeding: Bleeding esophageal varices are life endangering and require immediate action. Treatments which stop and reverse impacts of blood loss are:
- Elastic bands: Elastic bands are wrapped around the varices through endoscopy.
- Diverting blood flow: Your doctor might suggest a procedure known as trans-jugular intrahepatic portosystemic shunt (TIPS) which is mainly used when all other treatments have failed. A shunt is created which diverts the flow of blood from the liver.
- Restoring blood volume: A transfusion may be done to restore the amount of lost blood and a clotting factor which will stop the bleeding.
- Pressure to stop bleeding: Bleeding is restricted by applying pressure to the esophageal varices and may be done by inflating a balloon in a process known as balloon tamponade.
- Preventing infection: The bleeding increases the risk of infection and the doctor might give you an antibiotic to fight off the infections.
- Slow blood flow: Medicines such as octreotide and vasopressin are given to slow down the flow of blood to the portal vein.
- Replacing the diseased liver: Liver transplant is an option to replace the diseased liver with a healthy one. This is for people who mainly experience recurrent bleeding of esophageal varices.
Prevention of Esophageal Varices:
Currently, nothing can prevent this condition from occurring in people with cirrhosis. But you can avoid liver disease complications like esophageal varices by keeping your liver healthy. You can do so by:
- Avoiding drinking too much alcohol or even stop completely if you are already having a vulnerable liver.
- Eating a healthy diet which is full of fruits, vegetables, whole grains, low salt and lean sources of protein. You should avoid eating too much fatty and fried food.
- Maintaining a healthy body weight helps to keep your liver healthy. Obesity increases your risk of cirrhosis.
- Using household chemicals, cleaning supplies and insect sprays etc. sparingly and as per directions.
- Sharing needles, engaging in unprotected sex, etc. increases your risk of infections like hepatitis. Reduce this risk by getting tested and vaccinated against hepatitis.
It is very important to stick to your treatment plans and visit your doctor regularly if you have developed esophageal varices. At any moment, if you believe your esophageal varices may have ruptured, you need to go to the hospital immediately. Also, make sure to live a healthy lifestyle and keep your liver happy & safe.