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Esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus. [1] They are most often a consequence of portal hypertension, [2] commonly due to cirrhosis. [3] People with esophageal varices have a strong tendency to develop severe bleeding which left untreated can be fatal.
Despite treatment, re-bleeding occurs in about 7–16% of those with upper GI bleeding. [3] In those with esophageal varices, bleeding occurs in about 5–15% a year and if they have bled once, there is a higher risk of further bleeding within six weeks. [13] Testing and treating H. pylori if found can prevent re-bleeding in those with peptic ...
Depending on the amount of the blood loss, symptoms may include shock. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and rarer causes such as gastric cancer. The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine the hemoglobin.
Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; however, portal hypertension may cause several other more common sources of upper gastrointestinal bleeding, such as esophageal varices and gastric varices. On endoscopic evaluation of the ...
Signs and symptoms of portal hypertension include: Abdominal swelling and tightness due to ascites, which is free fluid in the peritoneal cavity [1] Vomiting blood (hematemesis) from gastric or esophageal varices; Anorectal varices [8] Increased spleen size (splenomegaly), [1] which may lead to lower platelet counts (thrombocytopenia)
Endoscopic image of esophageal varices being ligated with rubber bands. The varix being ligated has a longitudinal red mark on it, termed the wale mark. A wale mark, red wale sign or wale sign is an endoscopic sign suggestive of recent hemorrhage, or propensity to bleed, seen in individuals with esophageal varices at the time of endoscopy.
Esophageal varices and gastric varices result from collateral circulation in the esophagus and stomach (a process called portacaval anastomosis). [41] When the blood vessels in this circulation become enlarged, they are called varices. Varices are more likely to rupture at this point. [9] Variceal rupture often leads to severe bleeding, which ...
The esophageal veins drain blood from the esophagus to the azygos vein, in the thorax, and to the inferior thyroid vein in the neck. It also drains, although with less significance, to the hemiazygos vein , posterior intercostal vein and bronchial veins .