Oesophageal varices are swollen, enlarged veins in the oesophagus, the muscular tube that connects the throat to the stomach. These veins can become dangerously enlarged due to increased pressure in the liver’s blood vessels. When these varices rupture, they can cause severe bleeding, which may be life-threatening. The primary cause of oesophageal varices is obstructed blood flow in the liver, often due to conditions such as cirrhosis, hepatitis, or blood clots. This blockage increases pressure in the portal vein, a condition known as portal hypertension. As a result, blood is forced into smaller veins in the oesophagus, causing them to expand and form varices. About 30% of patients with liver cirrhosis develop oesophageal varices at the time of diagnosis, and it is more commonly observed in males.
Common Causes Include:
- Prehepatic Causes: Enlarged spleen or portal vein obstruction.
- Posthepatic Causes: Obstruction in the hepatic vein or heart conditions, such as right-sided heart failure.
- Intrahepatic Causes: Cirrhosis due to alcohol consumption, fatty liver disease, or viral hepatitis.
- Other Causes: Conditions like Budd-Chiari syndrome, sarcoidosis, and schistosomiasis can also lead to portal hypertension.
Symptoms of Oesophageal Varices
In many cases, oesophageal varices do not present symptoms until they bleed. When bleeding occurs, the symptoms can range from mild to severe, including:
- Dizziness
- Abdominal discomfort
- Blood in stool or vomit
- Jaundice (yellowing of the skin)
- Unexplained weight loss
- Itching
- Loss of appetite
- In severe cases, loss of consciousness
Grading and Diagnosis
Oesophageal varices are classified into three grades based on their size, which helps predict the risk of bleeding. To diagnose oesophageal varices, doctors may perform several tests, including:
- Blood tests: To check liver and kidney function.
- Endoscopy: A camera is used to examine the oesophagus for enlarged veins.
- CT scan or MRI: Provides detailed images of the liver, portal vein, and oesophagus.
- Doppler ultrasonography: Checks the blood flow in the veins.
Treatment Options for Oesophageal Varices
The main goal of treatment is to prevent varices from bleeding and to control bleeding if it occurs.
- Preventing Bleeding: Medications such as beta-blockers are prescribed to reduce blood pressure and decrease blood flow in the portal vein. In some cases, band ligation may be used to tie off the varices and prevent bleeding.
- Controlling Bleeding: In the event of a rupture, band ligation or procedures like transjugular intrahepatic portosystemic shunt (TIPS) may be performed to control the bleeding and reduce pressure in the portal vein.
Preventing Oesophageal Varices
Preventing oesophageal varices starts with maintaining liver health. Some key strategies include:
- Avoiding alcohol to reduce stress on the liver.
- Following a healthy diet rich in fruits, vegetables, and lean proteins while avoiding fatty and fried foods.
- Preventing hepatitis by practicing safe sex, not sharing needles, and getting vaccinated.
- Limiting exposure to harmful chemicals that can damage the liver.
Conclusion
Liver diseases are prevalent in India, largely due to infectious hepatitis and alcohol use. At Yupiter Hospital, we offer comprehensive care for oesophageal varices, providing expert treatment with 24/7 availability for emergency cases such as bleeding varices. Our specialists work closely with the Critical Care team to ensure patients receive the best possible care.
