Esophageal varices
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Template:DiseaseDisorder infobox-456.2 | }} In medicine (gastroenterology), esophageal varices are extreme dilations of sub-mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily.
Patients with esophageal varices have a strong tendency to develop bleeding.
Esophageal varices are diagnosed with endoscopy.
Contents |
Pathogenesis
The lower esophagus is a site of 'portosystemic anastamosis', meaning that venous blood flow in the portal circulation (i.e. draining into the portal vein) and the mesenteric circulation freely mix.
In situations where portal pressures increase, which are typically related to cirrhosis, there is dilation of veins in the anastamosis, leading to esophageal varices.
Varices can also form in other areas of the body, including the stomach (gastric varices), duodenum (duodenal varices), and rectum (rectal varices). Treatment of these types of varices may differ.
Treatment and the role of endoscopy
In emergency situations, the care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics (as infection is either concomittant, or a precipitant).
Therapeutic endoscopy is considered the mainstay of urgent treatment. Two main therapeutic approaches exist:
- Variceal ligation, or banding
- sclerotherapy
In cases of refractory bleeding, balloon tamponade may be necessary, usually as a bridge to further endoscopy, a transjugular intrahepatic portosystemic shunt (TIPS), or a distal splenorenal shunt procedure or a liver transplantation.
Prevention
Ideally, patients with known varices should receive treatment to reduce their risk of bleeding (Lebrec et al., 1981). The non-selective β-blockers (e.g., propranolol, timolol or nadolol) and nitrates have been evaluated for secondary prophylaxis. The effectiveness of this treatment has been shown by a number of different studies (Talwalkar JA & Kamath PS, 2004).
Unfortunately, non-selective β-blockers do not prevent the formation of esophageal varices (Groszmann RJ et al., 2005).
References
See also
Other causes of GI bleeding include:
| Health science - Medicine - Gastroenterology - edit |
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| Diseases of the esophagus - stomach |
| Halitosis | Nausea | Vomiting | GERD | Achalasia | Esophageal cancer | Esophageal varices | Peptic ulcer | Abdominal pain | Stomach cancer | Functional dyspepsia |
| Diseases of the liver - pancreas - gallbladder - biliary tree |
| Hepatitis | Cirrhosis | NASH | PBC | PSC | Budd-Chiari syndrome | Hepatocellular carcinoma | Acute pancreatitis | Chronic pancreatitis | Pancreatic cancer | Gallstones | Cholecystitis |
| Diseases of the small intestine |
| Peptic ulcer | Intussusception | Malabsorption (e.g. celiac disease, lactose intolerance, fructose malabsorption, Whipple's disease) | Lymphoma |
| Diseases of the colon |
| Diarrhea | Appendicitis | Diverticulitis | Diverticulosis | IBD (Crohn's disease, Ulcerative colitis) | Irritable bowel syndrome | Constipation | Colorectal cancer | Hirschsprung's disease | Pseudomembranous colitis |