The symptoms of esophageal varices often go unnoticed and are usually diagnosed through tests in patients with cirrhosis or portal hypertension.
Varices in the stomach
Esophageal varices are a serious medical condition commonly associated with advanced liver diseases such as cirrhosis, which may remain undetected until severe symptoms appear.
Esophageal varices are dilated and fragile veins that form in the lining of the esophagus, which is the tube connecting the throat to the stomach.
This type of varices is usually a consequence of increased pressure within the veins of the portal system, a condition known as portal hypertension. Although esophageal varices are mainly located in the esophagus, they can also form in the stomach, where they are called gastric varices.
Portal hypertension usually occurs due to the progressive scarring of the liver, a process called cirrhosis. This liver damage prevents blood from flowing freely through the liver, forcing it to find alternative pathways, which include the veins of the esophagus and the stomach.
But these veins are not designed to withstand such high pressure, which causes them to swell and become fragile; if these varices rupture, it can result in massive hemorrhages that put the person’s life at risk.
Why varices develop
The formation of esophageal varices is directly related to portal hypertension, which in turn can result from multiple causes:
- Liver cirrhosis: this is the most common cause of esophageal varices. Cirrhosis may be due to excessive alcohol consumption, chronic viral hepatitis, or non-alcoholic fatty liver disease.
- Portal vein thrombosis: obstruction of blood flow in the portal vein due to a clot can cause portal hypertension, increasing the risk of esophageal varices.
- Liver diseases: beyond cirrhosis, other liver diseases such as schistosomiasis —a parasitic infection— can cause liver damage and predispose patients to varices formation.
- Increased intra-abdominal pressure: conditions such as pregnancy or abdominal tumors can increase intra-abdominal pressure and contribute to the development of portal hypertension.
Regardless of their origin, esophageal varices often do not cause symptoms in their early stages, and their presence is usually detected through tests for other conditions such as portal hypertension or cirrhosis. However, once esophageal varices manifest symptoms, they may include:
- Hematemesis: vomiting blood is one of the most serious signs. It may appear bright red or resemble coffee grounds, the latter occurring when the blood has been partially digested.
- Melena: blood passing through the digestive system can appear as black, tarry stools, which is a sign of gastrointestinal bleeding.
- Anemia: continuous blood loss may cause anemia, with symptoms such as fatigue, weakness, and pale skin.
- Hypovolemic shock: if an esophageal varix ruptures, it can cause massive bleeding, resulting in a rapid drop in blood pressure and leading to shock, which requires immediate medical attention.
- Abdominal pain: although uncommon, some patients may experience discomfort in the upper abdomen.
- Symptoms of advanced liver disease: patients with esophageal varices often show signs of severe liver damage such as jaundice (yellowing of the skin or eyes), ascites (accumulation of fluid in the abdomen), or mental confusion caused by hepatic encephalopathy.
Treatment of esophageal varices
The treatment of esophageal varices has two main goals: on one hand, preventing hemorrhage, and on the other, managing the complications they cause.
For patients diagnosed with esophageal varices but who have not bled, preventive treatment is crucial and includes the use of medications aimed at reducing pressure in the varices by lowering portal blood flow. There is also a procedure known as endoscopic band ligation, which consists of placing elastic bands around the varices to reduce their size and the risk of gastrointestinal bleeding.
If an esophageal varix ruptures, emergency treatment is essential to save the patient’s life and may include blood transfusion, therapeutic endoscopy, vasoconstrictor medications, and in more severe cases, the use of an esophageal balloon tamponade —a temporary technique designed to compress varices to stop bleeding.
After a bleeding episode, the risk of recurrence is high, so secondary prevention is required with the support of medications and a procedure called transjugular intrahepatic portosystemic shunt (TIPS), which creates a connection between the portal vein and a hepatic vein to reduce portal pressure. This option is used in patients with recurrent hemorrhage.
In addition to all this, it is important to address the root cause of portal hypertension.
Although it is rare to identify the symptoms of esophageal varices in their early stages, it is important to pay close attention to overall health, especially liver conditions. Early diagnosis, prevention, and proper management are essential to reduce the risks associated with this condition.
At the ABC Medical Center’s Internal Medicine Department, we can provide you with specialized care. Contact us!
Fuentes:
MedlinePlus, MSD Manuals, Scielo
