Oesophageal Varices

Oesophageal varices are serious complications of liver disease and other abdominal diseases. Oesophageal varices are actually varicose veins of the lower aspect of the oesophagus that happens because the liver is cirrhotic and does not pass blood through the liver tissue very well. The blood backs up into the abdomen and oesophagus, causing dilated veins that are thinned at the lining and are prone to bleeding because of increased pressure and trauma to the veins. Ruptured oesophageal varices tend to bleed excessively so that the person can easily die within hours if the varices are not treated.

Only about a third of all people with oesophageal varices will actually have bleeding. This results in the vomiting of blood, a low blood pressure, black or bloody stools, a positive test for blood in the emesis or stool and shock. It is important to seek medical attention as soon as you have symptoms of bleeding or if you have cirrhosis and don't know if you have varices. There are things that can be done to treat oesophageal varices before they bleed that can save your life.

Symptoms of oesophageal varices are weight loss, having spider veins across your abdomen, being tired or weak, having easy bruisability, jaundice and itching of your hands and feet. Oedema of your abdomen, called ascites, can occur and you can get oedema of your hands and feet or legs as well. Hepatic encephalopathy or confusion from liver disease can happen if the ammonia level rises above normal.

If you do not catch oesophageal varices soon enough and begin bleeding, you need to call for emergency services as soon as possible. Even if you only have bloody or tarry stools, you should seek medical attention, especially if you feel weak and dizzy. Not always do you have vomiting with oesophageal varices.

The pathogenesis of oesophageal varices is a buildup of pressure in the portal vein of which the oesophageal veins are branches. Cirrhosis of the liver is the main reason why the portal vein can increase in pressure. Cirrhosis can be caused by alcoholism, primary biliary cirrhosis or severe fatty disease of the liver due to obesity and diabetes.

Heart failure can cause a buildup of pressure in the veins of the abdomen, including congestive heart failure, clots in the portal vein or clots within the splenic vein. Sarcoidosis is a cause of liver failure that can result in hypertension of the portal vein. Schistosomiasis is a parasitic infection that causes parasites to build up in the liver and increase the portal vein pressure.

The higher the pressure in the portal vein and the greater the bleeding disorder, the more likely it is to have oesophageal varices. Doctors do endoscopy to identify the bleeding areas, if possible and they can use endoscopy to identify swollen veins that have not bled yet. The worse the person's liver disease is, the greater is the chances of bleeding oesophageal varices. Those who continue to drink despite liver disease will have oesophageal varices more likely. If you have acid reflux disease or heart burn, you can damage the oesophageal varices and increase the chances of bleeding.

If you have a bleed from an oesophageal vein, you have a seventy percent chance of getting another bleed-one that could be fatal. Each successive bleed has a higher likelihood of your dying.

Doctors test for oesophageal varices by doing an upper GI endoscopy. A CT scan or MRI scan can be done to show oesophageal varices. Endoscopy, however, is the gold standard for both diagnosis and treatment of oesophageal varices.

The treatment of oesophageal varices includes lowering the blood pressure and stopping the bleeding by ligating the swollen vein. There are medications doctors can infuse into the varices in order to clot the blood and close off the varices for good. Elastic bands can be used to close off the veins. A medication known as ocreotide is used to reduce the pressure within the portal venous system. Balloon tamponade can be used to stop acute bleeding.