Esophageal varices

Diagnosis

A healthcare provider will assess your symptoms and health history, including any ongoing or long-term health conditions. Initially, they may conduct a physical examination to check for signs of bleeding, blood loss, or liver disease. Following this, they will perform blood tests and imaging studies to search for indications of portal hypertension and varices.

If there are no signs of active bleeding, your provider may start with noninvasive imaging tests. If these tests reveal evidence of varices, they may recommend an endoscopy. There are several imaging options, including:

• Computed Tomography (CT) scan.
• Magnetic Resonance Angiogram (MRA).
• Doppler ultrasound, which examines your blood vessels and blood flow.

An upper endoscopy, also known as an Esophagogastroduodenoscopy (EGD) test, is a procedure that examines your upper digestive tract, including your esophagus, stomach, and the upper part of your small intestine (duodenum). This procedure is carried out by a gastroenterologist, a specialist in digestive system diseases and endoscopic procedures.

During the endoscopy, a slender tube with a tiny camera on its tip, called an endoscope, is gently inserted through your esophagus into your stomach and duodenum. The camera transmits images to a monitor, allowing the endoscopist to observe the interior of your digestive tract. If any issues are identified, they can be addressed using specialized instruments passed through the endoscope.

Treatment

Preventing bleeding: The main goal when dealing with esophageal varices is to prevent them from bleeding, as this can be life-threatening. Several methods can help achieve this:

• Medications: Beta blockers like propranolol or nadolol can lower the pressure in the portal vein, reducing the risk of bleeding.
• Endoscopic band ligation: In cases where varices are prone to bleeding, a procedure called endoscopic band ligation can be done. This involves using a scope to place elastic bands around the varices, essentially blocking them to prevent bleeding. While generally safe, it can have rare complications like bleeding and esophageal scarring.

Treatment for Bleeding: If bleeding does occur, immediate treatment is crucial. Here are the methods used to stop bleeding and reverse blood loss:

• Elastic bands: Elastic bands can be used during an endoscopy to tie off the bleeding varices.
• Medications: Drugs like octreotide or vasopressin can slow down blood flow into the portal vein and are typically continued for up to five days after a bleeding episode.
• Transjugular intrahepatic portosystemic shunt (TIPS): This procedure creates a passage between the portal vein and hepatic vein to reduce portal vein pressure and often stop variceal bleeding. However, it carries risks like liver failure and confusion due to toxins bypassing the liver.
• Balloon tamponade: In some cases, a balloon can be inflated to apply pressure to the varices for up to 24 hours, temporarily stopping bleeding. This is a temporary measure before more definitive treatments like TIPS.
• Blood and clotting factor replacement: Patients may receive blood transfusions and clotting factors to replace lost blood and stop bleeding.
• Infection prevention: Due to the increased risk of infection during bleeding, antibiotics are often given to prevent infections.
• Liver transplant: For those with severe liver disease or recurrent bleeding from varices, a liver transplant may be necessary. However, organ availability is a challenge.

Preventing Re-bleeding: Esophageal varices are prone to re-bleeding. To prevent this, beta blockers and endoscopic band ligation are recommended. Regular follow-up endoscopies may be needed, and additional banding may be performed until the varices are either gone or small enough to reduce the risk of future bleeding.