Oesophagal varices are large, swollen veins located on the oesophagus. The oesophagus is a long narrow muscular tube, a part of the digestive system. It connects the throat to the stomach and helps transport food from the mouth to the stomach. Varices are veins that become swollen and enlarged. The enlargement of these veins can sometimes lead to rupture, bleeding, etc., which can be even fatal.
The main causes of oesophageal varices are obstructed blood circulation in the liver. Some clots or scarring in the liver, cirrhosis, schistosomiasis, hepatitis, etc., leads to the blockage in the blood circulation of the liver, which in turn leads to this condition. Close to 30% of all liver cirrhosis patients are observed to have developed varices at the time of the diagnosis.
Oesophageal varices are more commonly seen in males than females. About 50% of patients experience bleeding at some point, which can result in 10% to 20% mortality in the 6 weeks after the episode.
The liver is situated in the right upper part of the abdominal cavity and is responsible for removing toxins from the blood. The portal vein is responsible for the unobstructed blood supply to the liver. Any obstruction in the liver leads to increase in blood pressure in the portal vein.
Due to this increased pressure, the blood gets pushed back up in the smallest veins with thinner walls, causing them to expand and balloon, resulting in oesophageal varices.
Various conditions and diseases can cause portal hypertension. These can be classified as prehepatic causes, post hepatic causes, intrahepatic causes, etc., and these, in turn, cause esophageal varices:
- Prehepatic: An enlarged spleen causes portal vein obstruction, leading to oesophageal varices.
- Post hepatic: Obstruction in the hepatic vein, right-sided heart failure, etc., can lead to blood backing up in the portal vein, causing portal hypertension.
- Intrahepatic: Liver cirrhosis is caused by alcohol, fatty liver disease, and viral hepatitis. These conditions lead to the development of scar tissue in the liver, obstructing the blood flow of the portal vein.
- Other: Budd-Chiari syndrome, sarcoidosis, schistosomiasis, etc., are some other causes that lead to portal hypertension through various mechanisms.
Unless they bleed, oesophageal varices symptoms are hardly visible. The symptoms vary as per the intensity, and patients may experience a few or all of the symptoms as mentioned below:
- Dizziness
- Loss of appetite
- Jaundice or yellowing of the skin
- Blood in the stool
- Discomfort in the abdomen
- Bloody vomit
- Unintentional weight loss
- Itching
- In extreme cases, loss of consciousness
Oesophageal varices classification
Oesophageal varices are initially small and gradually grow to become larger in size.
Depending upon the size, oesophageal varices are classified as grade 1, grade 2, and grade 3. This grading helps predict the risk of bleeding and select the right mode of treatment.
While diagnosing oesophageal varices, our ENT specialists will examine the patient, look for signs and symptoms, ask about the medical history, and order some diagnostic tests and procedures. Following are some of the tests and procedures that help narrow down the diagnosis:
- Lab tests: The specialist may order a complete blood count, liver profile, kidney profile, and some other blood tests.
- Endoscopy: In this procedure, an endoscope (a small flexible tube with a camera on the tip) is passed down the oesophagus that helps the specialist look for any enlarged veins.
- CT scan or MRI: The ENT specialist can evaluate the computer-generated pictures of the oesophagus, portal vein, liver, etc., and get vital information regarding these organs, including the development of oesophageal varices.
- Doppler ultrasonography: This imaging shows if the portal vein and other important veins are patent or not and if there is unobstructed blood flow in these veins.
Once the varices have developed, the goal of the treatment is primarily to prevent bleeding from them and control the bleeding if it occurs.
- Prevent bleeding: Our specialists may prescribe the patient medication like beta-blockers which reduce blood pressure, which helps reducing the blood flow in the portal vein.
Alternatively, patients may have to undergo band ligation, where small elastic bands are tied around the varicose veins through endoscopy to prevent bleeding.
Endoscopic sclerotherapy can also be carried out where medication is injected into the varicose veins through endoscopy, causing them to shrink.
- Bleeding control: Bleeding oesophaeal varices present as a medical emergency where the patient has to be admitted to the hospital, and band ligation is performed to stop bleeding. Trans jugular intrahepatic portal-systemic shunting (TIPS) is another procedure that is effective in stopping variceal bleeding.
Generally, esophageal varices develop in people with a damaged liver. To prevent the formation of the varices, one must take care of their liver and try to keep it healthy through various lifestyle and diet precautions. Even if patients have a damaged liver, they must try to incorporate the following simple strategies to prevent the development of varices:
- Avoid alcohol: The liver is responsible for processing alcohol. Drinking too much alcohol can stress the liver and disrupt its function. Hence, it is better to avoid or at least restrict alcohol to the minimum.
- Eat healthily: Fatty and fried foods increase the amount of fat in the body and can damage the liver. Choose a diet rich in fruits, whole grains, and vegetables. Eat a lean source of protein. Exercising and maintaining body weight are also recommended.
- Reducing the risk of hepatitis: Having unprotected sex or sharing needles can increase the chances of developing hepatitis. It is better to use a condom to avoid this risk. Getting vaccinated against hepatitis A and B is another way to prevent this.
- Reduce chemical exposure: Since the liver removes toxins from the body, restricting the use of chemicals and working around chemicals carefully help in preventing the development of liver disease.
Following the above-mentioned steps not only helps keep the liver healthy but also helps in the prevention of oesophageal varices in general.
In India, liver disorders are seen often owing to the prevalence of infectious hepatitis and alcoholism. Oesophagel varices are commonly seen in people with a damaged liver.
CK Birla Hospital offers management of varices through various procedures conducted at our state-of-art facility. Our doctors are experts who are available 24×7 and work in close coordination with the Critical Care department to treat emergency cases, including bleeding oesophageal varices.
Our hospital has the latest facilities and technologies to manage these cases, along with the expertise of doctors who have handled 3000+ complex cases of Gastroentrology.
To understand more about oesophageal varices or surgical procedures for the same, visit CK Birla Hospital or book an appointment to connect with our expert Gastroentrologist, Dr. Anukalp Prakash.
