Oesophageal Varices

Oesophageal varices represent a severe medical condition that can lead to life-threatening bleeding in the food pipe. The condition requires immediate medical attention when symptoms appear, as bleeding from oesophageal varices can be severe and potentially fatal. This comprehensive guide explains everything patients need about oesophageal varices, from recognising early warning signs to understanding treatment options. 

What are Oesophageal Varices?

The medical condition known as oesophageal varices occurs when blood vessels in the lower part of the oesophagus become enlarged and swollen. These vessels are located in the lining of the oesophagus. This muscular tube links the mouth to the stomach.

When blood supply to the liver becomes blocked, typically due to scarring or clots, it creates a condition called portal hypertension. This increased pressure forces blood to find alternative pathways through smaller vessels in the oesophagus. These thin-walled vessels weren't designed to handle such large volumes of blood, causing them to balloon and weaken.

The severity of oesophageal varices disease can vary significantly, with key characteristics including:

• Varices can range from small to large
• The walls of these vessels become increasingly fragile
• They have a high risk of rupturing or leaking
• Up to 50% of cases may experience bleeding
• The condition worsens as underlying liver disease progresses

Oesophageal Varices Symptoms

Many patients with oesophageal varices experience no noticeable symptoms until complications arise. However, doctors often detect the condition during routine screenings for people with chronic liver disease.

When symptoms do appear, they often coincide with other signs of liver problems. Patients may experience:

• Jaundice - yellowing of skin and eyes
• Ascites - fluid buildup in the abdomen
• Upper abdominal pain
• Itching without a visible rash
• Confusion or disorientation
• Swollen legs and feet

The most serious symptom occurs when varices rupture and bleed. Patients might notice vomiting of blood, which can appear bright red or look like coffee grounds. Black, tar-like stools often indicate bleeding, though some patients may see bright red blood in their stool during rapid bleeding.

Causes of Oesophageal Varices

The development of oesophageal varices stems primarily from portal hypertension, which occurs when blood pressure increases in the portal venous system. This increased pressure forces blood to seek alternative pathways through smaller veins in the oesophagus.

Cirrhosis: Cirrhosis of the liver stands as the most common underlying cause. Various conditions can cause this scarring of liver tissue, such as alcoholic liver disease, chronic hepatitis, and nonalcoholic fatty liver disease. The scarred tissue blocks normal blood flow, leading to the formation of varices.

Several other conditions can trigger the development of oesophageal varices:
Blood clots in the portal or splenic vein

• Parasitic infections, particularly schistosomiasis
• Cardiovascular diseases, especially right-sided heart failure
• Enlarged spleen creating new blood vessels
• Granulomas of the liver

Risk Factors

The risk of bleeding from oesophageal varices increases significantly with certain factors. These include:

• Continued alcohol consumption
• High portal vein pressure
• Presence of large varices with red marks. 
• People with severe cirrhosis 
• Those who have experienced previous bleeding episodes 

Complications

The most serious complication of oesophageal varices is internal bleeding, which affects approximately half of all patients. When these enlarged veins rupture, they can cause severe blood loss that requires immediate medical attention. For individuals with cirrhosis who experience bleeding, the one-year survival rate stands at 50%.

Without prompt medical intervention, bleeding from oesophageal varices can lead to hypovolemic shock. It is a life-threatening condition where the body cannot maintain adequate blood supply to vital organs. In 40% of cases, bleeding may stop spontaneously, but medical treatment remains essential to prevent recurrence and manage potential complications.

Diagnosis

Doctors may use several diagnostic tools:

• Upper Endoscopy (EGD): Serves as the gold standard for diagnosis. During this procedure, a gastroenterologist passes a thin & flexible tube with a tiny camera attached down the patient's throat. This allows them to examine the oesophagus directly and measure any enlarged veins.
• CT Scans: Shows detailed images of blood vessels
• Doppler Ultrasound: Examines blood flow in portal and splenic veins
• Transient Elastography: Measures liver scarring
• MRA (Magnetic Resonance Angiogram): Creates detailed images of blood vessels

Oesophageal Varices Treatment

Treatment options for oesophageal varices focus on two main goals: preventing initial bleeding and managing active bleeding episodes. 

Preventive Treatments:

• Beta-blockers help reduce blood pressure in the portal vein.
• Endoscopic band ligation wraps tiny elastic bands around varices to cut off blood flow.
• Regular screening and follow-up appointments to monitor the condition

For patients experiencing active bleeding, emergency treatments become necessary. Doctors often use a combination of approaches, including:

• Medications like octreotide or vasopressin to slow blood flow to the portal vein
• Emergency endoscopic procedures to stop the bleeding.
• Transjugular intrahepatic portosystemic shunt (TIPS) in severe cases where other treatments prove ineffective creates a new connection between blood vessels in the liver to reduce pressure in the varices. 

When to See a Doctor

Emergency situations requiring immediate medical attention include:

• Vomiting blood (either fresh or coffee-ground appearance)
• Black, tar-like stools
• Bloody stools
• Severe weakness or dizziness
• Rapid heartbeat with cold, clammy skin

Preventions

Preventing complications from oesophageal varices requires a comprehensive approach that combines proper diet, medication, and lifestyle modifications. 

• A well-planned diet plays a vital role in prevention. Patients should follow these dietary guidelines:
  • Consume naturally soft foods like ripe bananas and cooked vegetables
  • Eat five small meals throughout the day instead of large meals
  • Include foods rich in insoluble fibre to prevent constipation
  • Avoid hard foods like raw carrots and taco shells
  • Choose low-fat options such as yoghurt and lean proteins
• Beta-blockers serve as the cornerstone of medical prevention, reducing the likelihood of bleeding by up to 50% in suitable patients. 
• Doctors may recommend endoscopic band ligation as a preventive measure for those who cannot take beta-blockers.
• Maintaining a healthy lifestyle significantly impacts prevention. This includes completely avoiding alcohol consumption and maintaining a healthy weight to protect liver function. 

Conclusion

Oesophageal varices demand serious attention and proper medical care to prevent life-threatening complications. Medical screening helps detect these enlarged veins early, while appropriate treatment reduces the risk of dangerous bleeding episodes. Patients with liver disease face the highest risk of developing this condition.

Quick action saves lives when bleeding occurs. Anyone experiencing symptoms like vomiting blood or black stools should call emergency services immediately. Regular check-ups, medication compliance, and lifestyle changes help prevent serious complications.

The combination of medical treatment and healthy lifestyle choices offers the best protection against bleeding episodes. Patients who follow their doctor's advice, take prescribed medications and maintain a proper diet significantly improve their chances of managing this condition successfully.

FAQs

1. Which is the most common cause of oesophageal varices?

Liver cirrhosis stands as the primary cause of oesophageal varices. This condition develops when healthy liver tissue is replaced by scar tissue, typically resulting from long-term liver damage. The scarring leads to increased pressure in the portal vein, forcing blood to find alternative pathways through the oesophageal vessels.

2. Can you recover from oesophageal varices?

Recovery from oesophageal varices depends mainly on the underlying liver condition and how well it responds to treatment. While the condition itself cannot be cured entirely, proper management can prevent bleeding and reduce complications. Variceal banding procedures show a success rate of 85-94% in preventing ruptures.

3. What to avoid with oesophageal varices?

Patients with oesophageal varices should avoid several things to reduce their risk of complications:

• Heavy lifting (anything over 30-40 pounds)
• NSAIDs
• Alcohol consumption
• Fatty and fried foods
• Sedentary lifestyle

4. What are the warning signs of oesophageal varices?

People should watch for these critical warning signs:

• Vomiting blood (fresh red or coffee-ground appearance)
• Black, tarry stools
• Lightheadedness or fainting
• Rapid heartbeat
• Cold, clammy skin
• Severe fatigue and weakness

Dr. Saurabh Lanjekar

CARE Medical Team