Esophageal Varices Management

Comprehensive Care for Life-Threatening GI Bleeding

What are Esophageal Varices?

Esophageal varices are enlarged veins in the esophagus, often caused by portal hypertension, a condition that occurs when blood flow through the liver is obstructed. These veins can rupture and bleed, leading to life-threatening complications.

At Central Gastro, we specialize in the diagnosis, treatment, and management of esophageal varices, using advanced endoscopic techniques and tailored care plans to prevent bleeding and ensure patient safety.

Causes of Esophageal Varices

Esophageal varices are most commonly associated with chronic liver disease or cirrhosis, which leads to increased pressure in the portal vein (portal hypertension). Other causes include:

• Blood Clots: Obstructions in the portal vein or splenic vein.
• Schistosomiasis: A parasitic infection that damages the liver.

Symptoms of Esophageal Varices

While esophageal varices may not cause symptoms initially, they can lead to serious complications when they rupture. Symptoms of bleeding varices include:

• Vomiting Blood (Hematemesis): Bright red or coffee-ground-like vomit.
• Black, Tarry Stools (Melena): Indicative of digested blood.
• Severe Weakness or Fatigue: Often caused by blood loss.
• Lightheadedness or Fainting: A sign of significant blood loss.
• Abdominal Swelling or Jaundice: Related to underlying liver disease.

If you experience these symptoms, seek emergency medical attention immediately.

Diagnosis of Esophageal Varices

At Central Gastro, we use advanced diagnostic tools to identify and assess esophageal varices:

• Upper Endoscopy (EGD): The gold standard for visualizing varices and assessing their size and risk of bleeding.
• Imaging Tests: Such as ultrasound, CT, or MRI to evaluate liver function and portal hypertension.
• Blood Tests: To assess liver function and clotting ability.

Treatment Options for Esophageal Varices

1. Endoscopic Band Ligation (EBL):

• How it Works: Rubber bands are placed around the varices during an endoscopy to stop bleeding and reduce the risk of future bleeding.
• Benefits: 
  • Highly effective for controlling active bleeding.
  • Minimally invasive and performed on an outpatient basis.

2. Endoscopic Sclerotherapy:

• How it Works: A special solution is injected into the varices to shrink them and stop bleeding.
• Ideal For: Patients with active bleeding or when band ligation is not feasible.

3. Non-Specific Beta-Blockers:

• How it Works: Medications like propranolol or nadolol reduce portal hypertension, decreasing the risk of bleeding.
• Ideal For: Preventing initial or recurrent bleeding.

4. Transjugular Intrahepatic Portosystemic Shunt (TIPS): 

• How it Works: A stent is placed between the portal vein and hepatic vein to lower pressure in the portal system.
• Ideal For: Patients with severe or recurrent bleeding not controlled by endoscopy or medication.

5. Tamponade with Balloon or Stent

• How it Works: A temporary measure using a balloon or Metal Stent to compress bleeding varices until definitive treatment is possible.
• Used In: Emergency situations.

6. Liver Transplantation:

• How it Works: For patients with advanced liver disease, a liver transplant may be the best long-term solution to prevent varices and manage portal hypertension.

Preventive Measures for Esophageal Varices

• Lifestyle Modifications: Avoid alcohol, maintain a healthy diet, and address the underlying liver disease.
• Regular Monitoring: Patients with cirrhosis should undergo periodic endoscopies to check for varices.
• Vaccinations: Protect against infections like hepatitis A and B that can worsen liver disease.